Get Petct Order Form - Mtbakerimagingfileswordpresscom

Filling out the PETCT order form correctly is essential for ensuring accurate scheduling and necessary preparation for the PET/CT study. This guide provides a step-by-step process to help users complete the form effectively.

Follow the steps to fill out the PETCT order form with ease.

1. Click the ‘Get Form’ button to download the PETCT order form and open it in the online editor.
2. Begin by entering the patient's details including their name, date of birth, height, weight, and telephone number. This information is critical for identification and scheduling.
3. Next, input the referring physician's name, telephone number, and office details. This ensures that all medical communications can be directed correctly.
4. Fill out the insurance information section. Provide details for both primary and secondary insurance, and remember to fax a copy of the insurance card or authorization along with the order.
5. Complete the prescreening questionnaire by indicating the patient's answers regarding pregnancy and diabetes. This is vital for preparation and safety purposes.
6. In the indications section, check the appropriate boxes that correspond to why the PET/CT scan is being requested. This will guide the patient's insurance coverage for the study.
7. Document the clinical history, including the primary question to be answered and the current diagnosis/ICD10 code, which will aid in the interpretation of results.
8. Have the referring physician or nurse practitioner sign the form and include their UPIN/NPI number and date of signing.
9. Review the completed form for accuracy, ensuring all required information is filled in. It is important to retain a copy of the form in the patient’s medical record.
10. Once everything is filled out and verified, users can save the changes, download, print, or share the form as needed.

Ensure timely and accurate appointments by completing the PETCT order form online today.