Get Prescription For Cone Beam Ct Imaging - Bsmilebuilderzb

Filling out the Prescription For Cone Beam CT Imaging - BSmilebuilderzb is an important step in ensuring efficient imaging services for patients. This guide provides clear, comprehensive instructions to help users complete the form accurately and confidently.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the Patient Identification section. Enter the patient's last name, first name, and date of birth in the format mm/dd/yyyy. Ensure all mandatory fields marked with an * are completed.
3. Fill in the patient's state and ZIP code, as well as their home address including city and phone number. This information helps to identify and contact the patient accurately.
4. Move to the Relevant History section. Indicate the anatomy to be scanned by selecting from the options provided: maxilla, mandible, both, quadrant, or TMJ. Check all that apply.
5. Next, specify the Diagnostic Objective. Select from options such as implant imaging, endodontic evaluation, pathology evaluation, TMJ study, or impacted tooth evaluation. List any specific teeth if necessary.
6. If applicable, include any special instructions related to the scan to provide additional context for the imaging process.
7. Fill in the Referring Doctor’s details. Provide the last name, first name, and phone number. Also, include the state, ZIP code, office address, and city of the referring doctor.
8. Finally, ensure the date is filled in and that the form is signed by the referring doctor, confirming the request for the imaging procedure.
9. Once all sections are completed, save your changes, and choose to download, print, or share the form as needed.

Complete your forms online today for an efficient imaging process.