Get Referral Form - Monticello Diagnostic Imaging

Filling out the Referral Form for Monticello Diagnostic Imaging is essential to ensure that patients receive timely and appropriate imaging services. This guide provides clear and systematic steps to assist users in completing the form online with confidence.

Follow the steps to efficiently complete the referral form online:

1. Press the ‘Get Form’ button to access and open the Referral Form in your digital editor.
2. Review the contact information section at the top of the form, ensuring that it reflects the correct imaging location. You will find several locations listed, such as Alliance, Burleson, Decatur, Denton, and Fort Worth.
3. Select the urgency of the referral by checking the appropriate box: Routine, ASAP, STAT, or Verbal (if verbal, provide the phone number for verification).
4. Fill in the patient's information including their full name, date of birth (DOB), and contact numbers (home and business/cell) to maintain accurate records.
5. Enter the insurance company details to confirm coverage. Provide the name of the ordering physician along with their contact information, including phone number and fax.
6. Complete the physician's address to facilitate future communications and referrals.
7. Indicate the referral coordinator’s name if applicable for better coordination of patient care.
8. Circle the relevant imaging study choices such as MRI, CT, Ultrasound, X-ray, etc. Be precise in circling the pertinent information to avoid errors.
9. Specify any special instructions or study needs in the designated area provided at the end of the study types.
10. Lastly, have the ordering physician sign and date the form to authenticate the referral. After completing the form, users can save any changes, download a copy, print it for personal records, or share it for further processing.

Complete your documents online today for efficient processing.