Get Vascular Lab Order Form

Filling out the Vascular Lab Order Form online can streamline the process of obtaining necessary vascular tests. This guide will walk you through each section and field of the form, ensuring that your submission is complete and accurate.

Follow the steps to successfully complete the Vascular Lab Order Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the patient information section. Enter the patient’s full name, date of birth (DOB), and home phone number. If there is a contact person other than the patient, provide their name in the designated field. Additionally, include the patient’s insurance provider and policy number.
3. In the reason for visit section, clearly indicate why the patient is seeking vascular testing. If a wet read is requested, be sure to check the appropriate box.
4. Fill out the ordering provider information. Enter the provider’s name, office phone number, and office fax number. Make sure to provide an authorized signature in the required area.
5. Specify the testing requested by selecting the appropriate procedures from the list provided. This could include tests such as carotid ultrasound, lower extremity venous ultrasound, or aorta ultrasound, among others. Mark all that apply.
6. If there are any special instructions or additional details relevant to the patient's visit or testing, include them in the designated space.
7. Once you have completed all sections of the form, ensure that all provided information is accurate. You can then save changes, download a copy for your records, print the form, or share it as needed.

Complete the Vascular Lab Order Form online to streamline your vascular testing process.