Get Request For Imaging Form - Sir Charles Gairdner Hospital

Filling out the Request For Imaging Form for Sir Charles Gairdner Hospital is an essential step in ensuring your imaging needs are addressed. This guide provides clear instructions to help you complete the form accurately and efficiently online.

Follow the steps to fill out the Request For Imaging Form online.

1. Use the ‘Get Form’ button to access the Request For Imaging Form and open it in your editor.
2. Begin with the patient information section. Fill in the patient surname, first name, clinic, address, unit number, ID, date of birth, and sex. Ensure to double-check the accuracy of this information.
3. Indicate whether the patient is an outpatient or inpatient. If applicable, complete the details for the outpatient appointment and the ward for an inpatient.
4. Provide three points of identification as required for validation. This may include details such as height and weight if applicable.
5. Check the box for interpreter needs and specify the language if required.
6. In the imaging requested section, specify if the request is urgent or elective and provide clinical details relevant to the request. Include any previous images in private if applicable.
7. Answer the obligatory questions regarding pregnancy status, risk factors, and any previous reactions to contrast, ensuring all relevant information is provided.
8. Complete the obligatory MRI questionnaire by checking the applicable boxes related to medical history and conditions.
9. Fill in the information regarding the requesting provider, including signature, provider number, consultant's name, and contact information.
10. Remember that the consultant's signature is mandatory for MRI requests. Once the form is completed, review all entries to ensure it is fully filled out.
11. Finally, save your changes in the editor, and download, print, or share the form as necessary.

Complete your Request For Imaging Form online today for efficient processing.