Get Mri & Ct - Mayfair Diagnostics

Filling out the MRI & CT requisition form is a crucial step in ensuring you receive the appropriate diagnostic services. This guide will provide you with clear instructions on how to complete the form accurately and efficiently.

Follow the steps to fill out the MRI & CT requisition form

1. Click ‘Get Form’ button to access the MRI & CT requisition form and open it in an online editor.
2. Begin by entering the patient information. Fill in the required fields such as home phone numbers, name, date of birth, and Saskatchewan Health Card number. Ensure the details are current and accurate.
3. Specify the date of request and appointment. Enter the date in the designated format (D/M/Y) and ensure that the time for the appointment is also indicated.
4. Select the exam type under the 'EXAM TYPE – MRI' section. You can choose a diagnostic exam from options such as brain, cervical spine, and other specified locations.
5. Complete the patient history section by checking relevant boxes for any applicable conditions such as claustrophobia or if the patient is pregnant.
6. Indicate the urgency level and renal function details. Select one of the options for urgency and fill in the creatinine and GFR information with the appropriate dates.
7. Enter the healthcare provider’s information, including the reference health provider's name, address, and contact details. Ensure this information is accurate for proper documentation.
8. The form requires a signature from the healthcare provider. Ensure this is done before finalizing the form.
9. Once all sections are completed, review the form for accuracy. After confirming that all information is correct, you can save changes, download, print, or share the completed form as necessary.

Complete your MRI & CT requisition forms online for a smooth and efficient process.