Get Pa Pennhip Radiograph Evaluation Application

Completing the PA PennHIP Radiograph Evaluation Application online is a straightforward process that ensures proper evaluation of your dog's radiographs. This guide will provide you with step-by-step instructions to help you navigate through the application effectively.

Follow the steps to fill out the application accurately

1. Click ‘Get Form’ button to access the application form in your browser.
2. Select your preferred payment option. You can choose between regular evaluation fee or priority evaluation, which comes with an additional charge. Indicate whether you will pay via check or credit card.
3. Provide the necessary hospital fax number for priority evaluation, if applicable.
4. Fill in the radiograph information section, which must be completed by a PennHIP member. This includes entering the member number, distractor number, date of the radiograph, member name, patient weight, and hospital case number if available.
5. Assess the clinical signs and indicate their severity by checking the boxes for mild, moderate, or severe. Also, provide the duration of symptoms in months and list all drugs used for restraint.
6. The dog's owner must complete the client information section. Ensure to provide your last name, first name, mailing address, city, state, postal code, country, and telephone number. Mark if the address has changed since the last evaluation.
7. Complete the dog information section, including the dog's registered and call names, sex, neuter/spay status, breed, and date of birth. You may also include details about permanent identification like registration number, tattoo number, and microchip number.
8. Answer important health-related questions regarding any prior hip surgery for the dog and any previous PennHIP radiographs. Include the OFA rating if known.
9. Review the consent statement regarding confidentiality and the use of your dog’s information. Sign the application to certify the accuracy of the provided details.
10. If you authorize the release of your dog's hip scores, provide your initials and the date. Ensure to submit this page along with the radiographs to the designated address.
11. After completing the form, you can save your changes, download, print, or share the application as needed.

Complete the PA PennHIP Radiograph Evaluation Application online today to ensure your dog's health evaluation is processed efficiently.