Get Hospital Scan Forms

Filling out the Hospital Scan Forms online can simplify the process of scheduling your imaging services. This guide will provide you with clear, step-by-step instructions to help you successfully complete your form.

Follow the steps to complete the Hospital Scan Forms online.

1. Click the ‘Get Form’ button to access the Hospital Scan Forms. This will allow you to open the document in a convenient format for filling out the required information.
2. Begin by entering the patient's name in the designated field. Ensure that it is spelled correctly, as this information is critical for record-keeping.
3. Provide the patient's Social Security Number (SSN) and date of birth (DOB) in the respective fields. This information is essential for identification purposes.
4. Fill in the patient's address and phone number. Accurate contact information is necessary for any follow-up communications regarding the appointment.
5. Indicate the patient's gender by selecting the appropriate option, either 'M' for male or 'F' for female.
6. Enter the primary insurance information, including the policy number. Ensure this information is correct to avoid insurance issues.
7. In the diagnosis section, include the required ICD9 code. This will help to identify the reason for the imaging study.
8. If required by the insurance policy, provide the authorization number in the appropriate field.
9. Choose the type of Computed Tomography (CT) scan by selecting the appropriate option from the list provided in the form, including options for the brain, chest, abdomen, and more.
10. Specify your appointment date, time, and location by filling those details into the corresponding fields.
11. After completing all sections, review the information for accuracy. Then, save your changes, download the completed form, and print it if necessary. You may also share the form as required.

Complete your Hospital Scan Forms online today for a smoother appointment process.