Get Cone Beam Ct Imaging Referral Form - Ndisca

Filling out the Cone Beam CT Imaging Referral Form is an essential step for facilitating accurate imaging services. This guide will provide you with clear, step-by-step instructions to ensure that you complete the form correctly and efficiently.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient details. Fill in the surname, first name, date of birth, home telephone number, mobile telephone number, and complete address in the designated fields.
3. Provide the reason for referral in the appropriate section. You may describe the patient's condition or specific needs detailed in the space provided.
4. Indicate whether relevant radiographs are being forwarded or if no radiographs are available by selecting the appropriate option.
5. Select the services required for 3D cone beam volumetric imaging by marking the relevant boxes, such as implants, orthodontics, or other specified services. If applicable, denote if you require a CD with DICOM files.
6. Circle the region of interest as needed, choosing from options such as maxillary sinuses or inferior alveolar nerve.
7. Fill in the details regarding conventional imaging options, selecting any appropriate imaging types, including panoramic or intraoral, by checking the boxes.
8. Specify the referring doctor's name and the date of the referral at the bottom of the form.
9. Once all the required fields have been completed, review your entries for accuracy, then save your changes, download, print, or share the form as needed.

Complete your Cone Beam CT Imaging Referral Form online today for a smooth imaging experience.