Get Radiology Exam Order Form - Umc Health System

Filling out the Radiology Exam Order Form accurately is essential for ensuring your medical imaging is scheduled and processed without delay. This guide provides a detailed walkthrough of each section of the form, empowering users to complete it online with confidence.

Follow the steps to complete the Radiology Exam Order Form effectively.

1. Click ‘Get Form’ button to access the Radiology Exam Order Form and open it for completion.
2. Begin by entering your patient name in the designated field. This information is crucial for identifying your medical records.
3. Input your medical record number in the corresponding section. If you are unsure of this number, please contact the radiology department.
4. Provide your phone number and date of birth in the respective fields, ensuring that accurate contact information is available.
5. Select the appropriate appointment type by circling the correct modality from the available options, such as CT scan, MRI, or ultrasound.
6. Clearly state the exam requested and any signs and symptoms relevant to your condition in the sections provided.
7. If applicable, describe any accidents leading to the exam request, including the type of injury and its location.
8. Fill in the specified date for when the exam is to be performed, along with any pre-certification or authorization numbers if already obtained.
9. Complete the section for appointment scheduling, including the name and contact information of the clinic location to send the report.
10. Make sure to fill in the details of the attending and ordering physicians, including their first and last names.
11. After reviewing all entries for accuracy, you can save your progress, download the form, or print it for submission.

Complete your Radiology Exam Order Form online today to ensure a smooth scheduling process for your medical imaging needs.