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How to fill out the Radiology Requisition Form online
Filling out the Radiology Requisition Form online can streamline the process of ordering necessary imaging tests for patients. This guide provides detailed instructions to assist you in completing each section of the form accurately.
Follow the steps to successfully complete the form
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the patient's name in the designated field. Ensure you spell the name accurately for proper identification in medical records.
- Select the patient's gender by marking ‘M’ for male or ‘F’ for female in the provided option.
- Input the patient's date of birth (DOB) in the specified format to ensure proper age-related considerations in diagnostics.
- Provide the patient's medical record number (MR #), if applicable, to link the requisition with existing medical records.
- Fill in the date of the requisition form completion to ensure a clear timeline of the request.
- Enter the name of the ordering physician in the ‘Ordering Physician’ field. Be sure to print the name clearly.
- Indicate any additional physician who should receive a copy of the order in the ‘cc Physician’ section.
- For urgent matters, include the contact number for the physician in the ‘For Critical Findings-Phone Number to Contact Physician’ section.
- Select the tests ordered by marking the appropriate boxes for X-Ray, Ultrasound (US), or Bone Density (DXA). This ensures the radiology department is aware of the required examinations.
- Provide a clear diagnosis or a description of the signs and symptoms leading to this requisition in the ‘Diagnosis/Signs and Symptoms’ section for better contextual understanding.
- The ordering physician must sign in the designated ‘Signature Of Physician Ordering Test(s)’ field, confirming the request.
- After filling out all sections, you can save, download, print, or share the completed form according to your needs.
Complete your Radiology Requisition Form online today to ensure timely imaging services for your patients.
Lab slip Lab medicine A form used to request specific lab tests eg, chemistry, hematology, microbiology, cytology, HIV, pathology, etc. See Results.
Fill Radiology Requisition Form
This section MUST be completed if requesting CT. Is Kidney Function abnormal? H Yes h No. Has patient had L-spine surgery? No Appointment Needed GENERAL X-RAY. Scheduled Appointment Required. A radiology requisition form is used to order medical imaging for a patient. General Radiology (X-Ray). Find all medical imaging requisition forms in PDF to refer a patient to the Joint Department of Medical Imaging. Download a form now.
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