Get Coc Diagnostic Imaging Request Form-e3 - Columbiaeye

Filling out the COC Diagnostic Imaging Request Form-e3 - Columbiaeye online can streamline the process of scheduling your diagnostic imaging services. This guide provides a step-by-step approach to correctly completing the form while ensuring all necessary information is captured accurately.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in the patient's name, address, date of birth (DOB), medical record number (MRN), and telephone number in the designated fields.
3. Enter the primary insurance provider's name and identification number in the appropriate section.
4. Record the referring physician's name and phone number to ensure proper communication regarding the patient's imaging.
5. Specify the date of service in the corresponding field to schedule the appointment effectively.
6. Provide your signature and date to authorize billing and affirm responsibility for payment, ensuring that all insurance details are submitted.
7. Select the diagnosis from the comprehensive list provided or specify another diagnosis if it is not listed.
8. Choose the procedures required by marking the corresponding codes for the diagnostic imaging services needed.
9. Add any special instructions, attending or resident details, and dilation orders where necessary.
10. Review all entries to confirm accuracy, then save changes, download, print, or share the completed form as needed.

Complete your COC Diagnostic Imaging Request Form-e3 online now!