Get Basha Mri

Filling out the Basha Mri form online can streamline the process of scheduling your MRI appointment. This guide provides clear, step-by-step instructions to ensure you complete each section accurately and efficiently.

Follow the steps to complete your Basha Mri form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Input the patient's information in the 'Patient Information' section, including the date, patient's name, date of birth, age, sex, and check if they experience claustrophobia.
3. In the 'Referring Physician Information' section, provide the physician's name, phone number, and address.
4. Indicate whether transportation assistance is required by notifying Basha Diagnostics' staff using the provided contact number.
5. Fill in the appointment date and time in the designated fields.
6. Select the type of MRI procedure required from the available options, such as 'Head,' 'Chest,' 'Spine,' etc. Be specific about any areas of focus by circling the relevant terms.
7. Complete the 'MUST BE COMPLETED BY ORDERING PHYSICIAN' section, which includes the rule-out diagnosis and any clinical information required by Blue Shield of Michigan for insurance purposes.
8. Ensure the physician's signature is included in the corresponding space, as this is necessary for processing the form.
9. After filling out the form, review all entries for accuracy and completeness.
10. Save your changes, and download or print the completed form if needed for submission or personal records.

Get started on filling out your documents online today.