Get 4167566118

Filling out the 4167566118 form is essential for patients requiring an MRI at NYGH. This guide provides a comprehensive walkthrough to ensure that users can complete the form accurately and effectively.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the document and open it in the editor.
2. Begin by filling in the 'Patient Information' section. Include the patient's full name, date of birth (in D/M/Y format), health card number, and contact details such as home and work/cell phone numbers. Ensure the patient's address is complete with the city and postal code.
3. In the 'Exam Request' section, specify the area to be scanned and include the name of the physician making the request. Add the diagnostic question and any pertinent clinical information that will assist the radiology team.
4. Complete the physician's information including their address, city/postal code, telephone number, fax number, and OHIP billing number. Remember to include the physician's signature at the bottom of this section.
5. Indicate the urgency of the request by scrolling through the listed options. Choose the appropriate priority level based on the patient's condition and select if a follow-up date is required.
6. Provide comprehensive details about any previous relevant exams. It's mandatory to attach all reports for earlier scans.
7. Answer all questions regarding the patient's medical history, specifically concerning any implants, surgeries, or relevant medical conditions. Include necessary details and procedures that pertain to current or past medical interventions.
8. Record renal function data and related medical history, especially if the patient is receiving IV contrast. Ensure clearance information is current, ideally within 45 days of the appointment.
9. Once all sections are completed, review the form for any errors or omissions. Ensure all necessary documentation is attached.
10. After confirming accuracy, choose to save changes, download, print, or share the completed form as needed.

Complete your documents online with ease and confidence.