Get Physician Order Form Mri

Filling out the PHYSICIAN ORDER FORM MRI online is a critical step in ensuring accurate scheduling and processing of MRI examinations. This guide will provide you with clear instructions on completing each section of the form effectively.

Follow the steps to fill out the PHYSICIAN ORDER FORM MRI online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the appointment date and time in the provided section to indicate when the MRI is to be performed.
3. Select the type of request by checking the appropriate box for either 'Routine' or 'STAT'.
4. Choose the location where the MRI will be performed from the listed facilities, ensuring that you note the correct facility code.
5. Fill in the patient information, including name, date of birth, social security number, weight, and contact details. If applicable, include insurance information.
6. In the injury and pain information section, provide the diagnosis using ICD-10 codes, the date of injury, location of pain, severity, mechanism of injury, and any relevant history.
7. Complete the referring physician information by entering the physician's name, contact phone number, address, and office location. The physician must also sign the form.
8. Select the technology for the MRI scan, indicating whether it will be done with 1.5T high-field or 3T high-field open technology.
9. Fill in lab values if a contrast is used, including creatinine and BUN levels, and indicate any necessary lab dates.
10. Select the specific MRI scan information related to neurology, spine, body, breast, musculoskeletal, vascular imaging, or prostate as needed.
11. Finally, review the completed form for accuracy and completeness before saving changes, downloading the document, or sharing it as necessary.

Complete your PHYSICIAN ORDER FORM MRI online today to ensure timely processing of your MRI request.