Get Mri Order Form

Completing the MRI order form online is a straightforward process that ensures your imaging needs are met efficiently. This guide will provide you with clear, step-by-step instructions to accurately fill out each section of the form, streamlining your experience.

Follow the steps to successfully complete the MRI order form online.

1. Click the ‘Get Form’ button to obtain the MRI order form and open it in your preferred editor.
2. Fill in the preferred exam date and time, or select 'First Available' if you are flexible.
3. Provide the scheduled date and time for the MRI, if already arranged.
4. Select the location for the MRI from the available options: Gastonia, Belmont, or Shelby.
5. Complete the insurance authorization fields. Include any relevant insurance information for primary and secondary coverage.
6. Enter the patient's full name, date of birth, height, and weight.
7. Fill in the patient's social security number, home phone number, and any other contact numbers.
8. Identify the ordering physician's name and include their signature in the designated area.
9. Provide the name of the person scheduling the appointment along with their contact phone number and email.
10. Note any previous studies or locations relevant to the imaging.
11. Indicate whether a CD should be sent with the patient and specify any special instructions or medical needs.
12. Document previous surgeries and any history of significant health issues, such as cancer.
13. Mark any relevant details about metal objects in the body, potential claustrophobia, allergies, and the possibility of pregnancy.
14. Choose the appropriate MRI procedure(s) from the section provided, ensuring to include corresponding CPT or ICD-9 codes.
15. Review all entered information for accuracy before finalizing.
16. Once completed, you can save changes, download, print, or share the MRI order form as needed.

Complete your MRI order form online today to ensure timely imaging services.