Get Ct Scan Request Template

Filling out the Ct Scan Request Template is an important task that ensures accurate information is provided for your medical imaging procedure. This guide will walk you through each step of the form, helping you complete it efficiently and correctly.

Follow the steps to complete the Ct Scan Request Template.

1. Press the ‘Get Form’ button to access the template and open it in your online editor.
2. Begin by entering the patient's name in the designated field at the top of the form. Ensure that the name is spelled correctly as it will be used for identification purposes.
3. Next, fill in the date of the study, physician's name, date of birth, and age of the patient. Accuracy is crucial for proper record-keeping.
4. In the general medical history section, provide reasons for the exam. Be specific about any current symptoms or conditions being assessed.
5. Respond to the questions regarding a history of cancer and surgeries in the scanned area. Include relevant details, such as types of cancer or dates of surgeries.
6. Address the pregnancy section by indicating if there is any chance of pregnancy. If yes, it’s important to inform the technologist immediately.
7. Complete the asthma/allergy history section by answering questions about asthma attacks, use of inhalers, hospitalizations, or severe allergic reactions.
8. Next, indicate if this is the first instance of receiving x-ray contrast medication and specify any previous allergies to contrast agents.
9. Provide relevant details regarding steroid premedication history, if applicable. Indicate any recent usage of steroids.
10. Fill in the kidney function questions, particularly regarding diabetes and family history of kidney issues, ensuring to check for any required recent tests.
11. Complete the cardiac and thyroid history sections by answering the respective questions accurately.
12. In the consent section, read through the risks associated with intravenous contrast and indicate your understanding and consent by providing your signature and the date.
13. Finally, review all entered information for accuracy. Once satisfied, save your changes, and utilize the options to download, print, or share the completed form as needed.

Start completing your Ct Scan Request Template online today for an efficient medical imaging experience.