Get Bc Victoria Breast Imaging Requisition - Cml Healthcare

Filling out the BC Victoria Breast Imaging Requisition is an important step in ensuring that patients receive the necessary breast imaging services. This guide provides clear and comprehensive instructions on completing the requisition form online, tailored for users of varying experience levels.

Follow the steps to complete the requisition form online:

1. Press the ‘Get Form’ button to obtain the requisition form and open it in your editing tool.
2. Begin by filling in the physician's name and their MSP practitioner number, which can also be stamped if applicable.
3. Indicate the billing option by selecting one of the available choices: MSP, ICBC, WCB, or other.
4. Enter the patient’s personal health number, date of birth (formatted as YYYY/MM/DD), surname, first name, and middle initial.
5. Provide the patient's telephone number including the area code, and full address along with the postal code.
6. Select the gender of the patient by checking the appropriate box.
7. Indicate if the patient is pregnant by checking 'Yes' or 'No'.
8. Choose the type of imaging required by checking either 'Diagnostic Mammography' or 'Ultrasound'.
9. Check the appropriate box for the request to proceed to further imaging if indicated.
10. Fill in the medical history sections, indicating whether the patient has had previous mammograms, biopsies, or surgeries.
11. Provide details about any hormone therapy the patient has undergone.
12. Indicate any family history of breast cancer, specifying the relationship.
13. Document the patient's menstrual history, including the last menstrual period (LMP) date and menopause age.
14. Check the relevant present complaints, such as lumps or tenderness, and detail any other specifics if necessary.
15. Mark the areas of concern on a diagram if applicable.
16. Ensure the signature of the requesting physician is signed on the form.
17. Finally, save the changes, and choose to download, print, or share the completed form.

Complete your document online now to ensure timely breast imaging services.