Get Ct Chest Screen Evaluation Form - Tri-city Radiology

Completing the CT Chest Screen Evaluation Form is an essential step in providing important information to your healthcare provider. This guide offers clear, step-by-step instructions to help you accurately fill out the form online, ensuring your evaluation process runs smoothly.

Follow the steps to successfully complete the CT chest screen evaluation form.

1. Click the ‘Get Form’ button to access the CT Chest Screen Evaluation Form and open it for editing.
2. Begin by entering your personal information in the provided fields, including your name, age, weight, and the date. Make sure all information is accurate to facilitate your evaluation.
3. In the section about your chief complaint, provide a detailed description of the reason for your visit to the doctor. This helps in understanding your symptoms better.
4. Indicate whether you currently smoke by selecting 'YES' or 'NO.' If applicable, specify how many years you have been smoking and the average number of cigarettes you consume daily.
5. Circle any symptoms you are currently experiencing, such as weight loss, fever, or chest pain. This section is crucial for identifying your health status.
6. Answer questions about any past surgeries on your chest and detail any serious medical conditions, particularly cancer, to provide a comprehensive health background.
7. Indicate if you have undergone other imaging tests for your chest by responding 'YES' or 'NO.' If yes, list the type of tests (e.g., X-Rays, CT Scans) along with the dates and locations of these tests.
8. For female patients, answer whether you are pregnant and, if not, provide the date of your last menstrual period (LMP). This information is essential for ensuring the safety of your evaluation.
9. Review all the information you have entered for accuracy before proceeding. Ensuring correctness can help your healthcare provider make informed decisions.
10. Once you are satisfied with your form, you can save your changes, download, print, or share the completed document as needed.

Complete your CT chest screen evaluation form online today for a thorough and efficient assessment.