Get Format Mri-ct Scan Authorization - Copy

Filling out the Format MRI-CT Scan Authorization - Copy can seem challenging, but understanding the components and steps can simplify the process. This guide offers a comprehensive overview, helping you complete the form with confidence.

Follow the steps to complete your authorization form effectively.

1. Click ‘Get Form’ button to access the authorization form in your online editor.
2. Start by entering the name of the hospital or polyclinic where the procedure will take place at the top of the form.
3. Fill in the file number and date as required to identify your submission.
4. Address the letter to the Centre Manager at the DAK Empanelled Diagnostic or Imaging Centre.
5. Clearly specify the type of test being authorized by encircling the appropriate option (MRI, CT Scan, PET CT, etc.).
6. Input the patient's details: the person's full name, and relation to the person providing the authorization (if applicable) such as son or daughter.
7. Provide the patient's address, ensuring accuracy in the details for verification.
8. Include the specific department that has referred the patient for the imaging procedure.
9. Record the code number as per the DGEHS list if applicable.
10. Confirm the patient’s residency by indicating the proof of address document they have submitted.
11. Outline the billing process, noting that the payment will be at DGEHS approved rates and no payment is required from the patient.
12. Once all fields are complete, review the information for accuracy before finalizing.
13. After validating the details, save your changes, and utilize options to download, print, or share the completed authorization form.

Complete your MRI-CT Scan Authorization - Copy online today to ensure a seamless process.