Get Ct Computed Tomography (ct) Requisition - Providence Health Care

Completing the CT Computed Tomography (CT) Requisition is a straightforward process that ensures efficient scheduling and management of medical imaging services. This guide provides detailed, step-by-step instructions for filling out the form online, allowing users to navigate each section with clarity.

Follow the steps to complete the requisition accurately.

1. Press the ‘Get Form’ button to access the CT Computed Tomography (CT) Requisition form and open it in your editor.
2. Begin by entering the patient's surname, first name, and date of birth (in month/day/year format). Ensure accurate spelling and completeness.
3. Fill out the permanent address, including postal code, and contact numbers: cell phone, home phone, and work phone.
4. Indicate the patient's health care number, age, and mark the appropriate boxes for MSP, WCB, ICBC, or other relevant insurance information.
5. Select the exam requested and address any infection concerns, pregnancy status, previous IV contrast reactions, and diabetes mellitus history by circling 'YES' or 'NO'.
6. Complete the relevant history for the scan. Include creatinine results if the patient has diabetes, and indicate if the patient is taking and their renal function status.
7. If applicable, report the patient's weight and any allergies, specifying details where necessary.
8. Provide details on relevant previous exams, selecting from X-Ray, CT, or U/S. Include the date and location of these exams.
9. Finish by recording the date and obtaining the signature of the authorizing physician. Print their name and practice number below the signature.
10. At the conclusion of the form, ensure you check the additional copy of the report section if needed, and specify the department for sending the report.
11. Once all sections are completed, save the changes, and choose the desired option to download, print, or share the requisition form.

Complete the CT Computed Tomography (CT) Requisition online today for efficient medical imaging management.