Get Ct Scan Questionnaire Dental Non-contrast - Webdoc Nyumc

Filling out the CT Scan Questionnaire for dental non-contrast procedures online is essential for ensuring accurate medical evaluations. This guide will walk you through each step of the process, ensuring that you provide the necessary information clearly and thoroughly.

Follow the steps to complete the questionnaire effectively.

1. Begin by clicking the ‘Get Form’ button to access the CT Scan Questionnaire. This will enable you to view and complete the form within your preferred online platform.
2. In the first section, enter your full name, the date, date of birth, age, and sex. Ensure that each entry is accurate and double-check for any misspellings.
3. Specify the name of your doctor in the designated field.
4. Describe the complaints or symptoms that prompted you to seek this medical evaluation in the appropriate section.
5. Indicate how long you have experienced these symptoms, and answer whether there have been any changes to the symptoms by selecting 'Yes' or 'No'.
6. If you are being treated for any other medical issues, list them in the provided space. If not, you can leave this section blank.
7. Answer whether you are currently taking any medications. If yes, specify the medications in the outlined area.
8. Indicate if there is any chance of pregnancy by selecting 'Yes' or 'No'.
9. If you have had previous dental CT scans, answer accordingly, and provide details if you have ever received radiation treatment or chemotherapy.
10. Respond to questions regarding the provision of a stent/appliance for use during your scan, as well as any removable dentures or partials you may wear.
11. Review the payment and insurance information, acknowledging that this dental scan is not covered by medical insurance and that payment is required at the time of service.
12. Finally, remember to sign the form, accompanied by the date of service and any necessary staff signatures if required.

Complete your CT Scan Questionnaire online today to ensure a smooth and efficient medical process.