Get Petct Patient Request Form - Alliance Medical Uk

This guide provides step-by-step instructions on completing the PETCT Patient Request Form for Alliance Medical UK online. Follow these directions carefully to ensure all necessary information is provided accurately and completely.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the patient details section. Complete all fields marked with an asterisk, including the patient category, name, address, postcode, and NHS number.
3. Indicate the patient's mobility status by selecting the appropriate option from the list provided.
4. Fill in the clinical information section, providing the required scan date, diagnosis, and any relevant medical history, including previous treatments and surgeries.
5. In the safety check section, answer all questions regarding the patient’s health status, including pregnancy status and any known medical contraindications.
6. Complete the referrer’s details section with the name, job title, hospital, and contact information. Ensure to indicate if previous imaging has been submitted.
7. Lastly, sign and date the form as the referrer, confirming all provided information is accurate. Review all sections to confirm that no required fields are left incomplete.
8. Once all sections are filled out, save any changes made to the form, and consider downloading, printing, or sharing the completed document as needed.

Complete your PETCT Patient Request Form online to ensure prompt appointment allocation.