Get Uva Eeg Request Form

Filling out the Uva Eeg Request Form online is a crucial step for ensuring proper care and documentation for patients undergoing EEG procedures. This guide provides clear instructions to help users complete the form effectively and efficiently.

Follow the steps to fill out the Uva Eeg Request Form with ease.

1. Click the ‘Get Form’ button to access the Uva Eeg Request Form and open it in the online editor.
2. Begin by entering the patient's medical record number (MRN) at the top of the form, followed by their name and admission date in the designated fields.
3. Provide the case number and enter the name of the referring physician in the appropriate sections of the form.
4. Complete the sections for injury date, injury type, and treatment time as applicable to the patient's case, ensuring all information is accurate.
5. Select the proper billing area, ensuring to choose between options such as 'EEG Lab' or 'Outpatient' as fits the situation.
6. Fill in details pertaining to the medical procedures by selecting the corresponding routine EEG codes or ICD-9 diagnosis codes from the list provided in the form.
7. If applicable, indicate services that may require special modifiers, ensuring that you circle the appropriate codes as instructed.
8. Once all necessary fields are filled out, review the entire form for accuracy and completeness.
9. At the end of the process, you can choose to save changes, download a copy, print the form, or share it as needed.

Complete your online forms efficiently and ensure proper documentation by using the Uva Eeg Request Form today.