Get Patient Scheduling / Order Form - Fort Payne Imaging

Filling out the Patient Scheduling / Order Form for Fort Payne Imaging is essential for ensuring accurate scheduling and proper documentation for your imaging needs. This guide will provide you with clear, step-by-step instructions on how to complete the form effectively online.

Follow the steps to complete the Patient Scheduling / Order Form seamlessly.

1. Press the ‘Get Form’ button to access the Patient Scheduling / Order Form and open it in the editor.
2. Begin by entering the patient's name in the designated field. Ensure that the name is spelled correctly, as this will be used for identification purposes.
3. Input the patient's date of birth in the required format. This information is critical for verifying the patient's identity and medical records.
4. Provide the patient's contact information, including home, work, and cell phone numbers. Confirm accuracy to prevent any communication issues.
5. In the insurance verification section, enter primary insurance details, including the insurance policy number and any necessary case information. This is required for pre-authorization and billing purposes.
6. Specify the type of imaging required by selecting the appropriate options from the provided list. Indicate if the imaging should be performed with or without contrast where applicable.
7. If applicable, provide information about prior surgeries or medical conditions relevant to the procedure. This information can aid in ensuring safety and accuracy during the imaging.
8. Complete the referring physician's information, including name, signature, and any necessary identification numbers. This ensures the proper coordination of care.
9. Review the entire form for accuracy and completeness, ensuring all required fields are filled out correctly.
10. Once completed, save any changes made to the form. You may download, print, or share the form as needed for submission.

Start filling out your Patient Scheduling / Order Form online today for a smoother imaging experience.