Get Dfw West Script Pad - Touchstone Medical Imaging

Navigating the DFW West Script Pad for Touchstone Medical Imaging can be straightforward with the right guidance. This guide provides clear, step-by-step instructions to help you successfully complete the form online.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin completing the form by entering the appointment date in the ‘Appt. Date’ field. Ensure you select the correct date for your imaging procedure.
3. Fill in the ‘Appt. Time’ field with the time of your appointment, making sure it aligns with your schedule.
4. Select the facility where you will be receiving your imaging. You can choose from multiple locations, such as Arlington, Burleson, or Denton. Mark your selection clearly.
5. Provide your personal information in the 'Patient Name', 'DOB', 'Cell Phone', and other relevant fields. This information is vital for identification and communication.
6. Enter your insurance details in the 'Insurance' and 'Insurance ID#' fields to ensure coverage verification.
7. Fill in the contact details including your home phone and work phone numbers so that you can be reached if necessary.
8. If applicable, include the 'Referring Physician Signature.' If this is urgent, indicate this with 'STAT' for a quick response.
9. Describe any diagnosis related to your imaging request in the 'DIAGNOSIS' section and include any relevant previous studies.
10. Select the relevant types of imaging requested by checking the appropriate boxes, including options like MRI, CT, or Ultrasound.
11. Review the form for completeness and accuracy before proceeding. Ensure that all necessary fields are filled out and that you have provided all required information.
12. Once you have completed all the sections, you can save changes, download, print, or share the form as needed for your records or for submission.

Complete your documents online today to ensure a smooth and efficient appointment!