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Get Tx Houston Mri Order
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How to fill out the TX Houston MRI Order online
This guide provides a comprehensive overview of how to complete the TX Houston MRI Order form online. Whether you are a first-time user or need a refresher, this step-by-step approach ensures you accurately fill out the required information.
Follow the steps to complete the TX Houston MRI Order form efficiently.
- Press the ‘Get Form’ button to download the TX Houston MRI Order form and open it in your preferred editor.
- Begin by entering the order date at the top of the form.
- Select your preferred location by checking the corresponding box. Refer to the included map if needed.
- Fill in the patient's name, date of birth, sex, cell phone number, home phone number, and the last four digits of their Social Security number.
- Indicate the insurance carrier by providing the name, followed by the attorney's name and phone number if applicable.
- If this MRI is related to a work-related injury, provide the worker's compensation date of injury and any ID or group numbers required.
- Enter the referring physician's name, specialty, contact phone number, and fax number. Ensure this section is printed clearly.
- Provide an authorization signature confirming that Houston MRI & Diagnostic Imaging can verify insurance, obtain pre-certification, and schedule the patient.
- Complete the report request section by checking the appropriate options, such as Web PACS or email.
- Fill in the image access preferences, specifying whether you would like report only access or web access, and check your choices.
- Next, indicate the necessary CPT codes for the MRI procedures you are requesting. Make sure to select the correct codes based on your diagnosis.
- In the diagnosis section, provide a brief description of the patient's condition as needed for the MRI procedures.
- Once all relevant sections are completed, review the form for any errors or missing information.
- After verifying the details, you can save your changes, download a copy for your records, print the form, or share it as necessary.
Complete your TX Houston MRI Order online today for efficient processing.
To acquire a doctor referral for an MRI, discuss your health issues with your primary care physician. Be prepared to describe your symptoms and any treatments you've tried. Your doctor will then assess your needs and determine whether an MRI is necessary. A TX Houston MRI Order can assist in taking the next steps if a referral is provided.
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