Get Plano Mckinney V3 - Preferred Imaging

Filling out the Plano McKinney V3 - Preferred Imaging form online can streamline your appointment process and ensure all necessary information is captured accurately. This guide walks you through each section and field of the form, providing clear instructions tailored to meet your needs.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access the document and open it in the online editor.
2. Enter today's date in the designated field, ensuring to use the correct format. This is an essential step as it indicates when the appointment request is made.
3. Fill in the patient name field with the full legal name of the person to be examined. Be sure to double-check spelling for accuracy.
4. Provide the patient's date of birth in the specified format. This helps in verifying the patient's identity.
5. Enter the employer's name and the patient's Social Security number in the respective fields, ensuring confidentiality and accuracy.
6. Fill in the insurance information, including the insurance provider, group number, and policy number as required.
7. Indicate the authorization required for insurance coverage, if applicable. Make sure to check if pre-authorization is needed.
8. Provide the patient's contact information, including cell phone, home phone, and work phone. This allows for better communication regarding the appointment.
9. Specify the appointment date and time preferred by selecting from the options provided.
10. Indicate if the patient is pregnant by selecting 'Yes' or 'No.' This information is crucial for examination safety.
11. Enter the referring physician's name and ensure to include their printed signature at the end of the form. This is necessary for the referral process.
12. Fill out the diagnosis and reason for the exam with detailed information to inform the imaging staff.
13. Select the required exams and imaging techniques from the provided options, clearly marking any special requests.
14. Remember to sign the form where indicated, as well as any required secondary signatures for sedation, if applicable.
15. Once all fields are completed, save your changes, and utilize options to download, print, or share the form as needed.

Complete your document online today for a streamlined imaging experience.