Get Ct Scan Referral

Completing the CT scan referral form online is an essential step in ensuring patients receive the appropriate imaging services. This guide provides clear instructions to help users navigate and accurately fill out each section of the form.

Follow the steps to complete your CT scan referral form effectively.

1. Press the ‘Get Form’ button to access the CT scan referral and open it for editing.
2. Enter the patient's full name in the space provided. Make sure to double-check the spelling for accuracy.
3. Fill in the date of the referral in the designated area. Use the format indicated (DD/MM/YY).
4. Provide the patient's address in the specified field, ensuring all lines are complete for contact purposes.
5. Input the patient's date of birth using the format (DD/MM/YY).
6. Enter contact numbers for the patient under cell, work, and home phone sections. Ensure that at least one number is provided.
7. List any known allergies in the dedicated field. This is important for patient safety during the scan.
8. Indicate the patient's gender by checking the appropriate box for either male or female.
9. Fill out the appointment date and time fields to specify when the CT scan is scheduled.
10. Complete the clinical information regarding the body areas of concern. Check all that apply based on the patient's symptoms.
11. If the patient is sensitive to IV contrast media containing iodine, select the applicable options and ensure the referring physician's prescriptions are noted.
12. Indicate whether the patient is on dialysis. If yes, refer to the requirements stated in the form.
13. Fill in the BUN and creatinine levels if applicable. Note: No blood tests are necessary for musculoskeletal CT scans.
14. Specify the symptoms or reasons for the CT scan in the provided section to inform the medical team.
15. Enter the name and contact information of the referring physician. This should include phone numbers for both office and cell.
16. Obtain the referring physician's signature to validate the referral.
17. Finally, review all entries for accuracy and clarity. Save the completed form, and download or print it for distribution as needed.

Complete your CT scan referral online today and ensure timely and accurate imaging services.