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Filling out the MRI requisition form accurately is essential for efficient processing and to ensure timely medical care. This guide provides step-by-step instructions to help you complete the form with ease.

Follow the steps to complete your MRI requisition form.

1. Press the ‘Get Form’ button to access the MRI requisition form and open it in your preferred online editor.
2. Enter the referring physician's last name, followed by their first name and contact information. This ensures that the medical staff can reach out if there are any questions.
3. Provide the patient's health number and date of birth in the specified formats. Accurate information here is crucial for identifying the patient.
4. Fill in the patient's home address, including street, apartment number, city, province, and postal code. This information is needed for record-keeping and communication purposes.
5. List any copies of the exam report that need to be sent to additional names and fax numbers. This allows relevant parties to receive necessary information about the examination.
6. Indicate the type of imaging required (e.g., MRI, CT, US) and include the place and date of the exam.
7. Complete the patient screening information, ensuring to answer all questions regarding allergies, previous medical work, and any foreign objects in the body.
8. Provide additional medical history, including any surgeries and their details, along with a certification statement confirming the accuracy of the information entered.
9. Sign and date the form at the designated areas, ensuring that the signer is identified correctly as the patient or other appropriate representative.
10. Once finished, save your changes, and consider downloading or printing the completed form for your records, or share it as needed for further processing.

Complete your MRI requisition form online now to ensure timely medical attention.