Get Ct Requisition This Form Can Be Found On Www.swpca

Completing the CT requisition form is a crucial step in ensuring that individuals receive the correct imaging services. This guide provides clear and concise instructions to help users fill out the form accurately and efficiently.

Follow the steps to successfully complete the CT requisition form.

1. Click ‘Get Form’ button to access the CT requisition form and open it for editing.
2. Select the hospital site by checking the appropriate box. Ensure the selection corresponds to where the service is needed.
3. Fill in the patient information fields including surname, first name, middle initial, gender, date of birth, and address details. Accurate information is vital for correct identification.
4. Provide the health card number, version code, and any relevant third-party numbers as applicable.
5. Indicate the patient's contact numbers, specifying daytime, evening, and cell phone numbers for effective communication.
6. Select the patient status from the options provided (Outpatient, Long Term Care, Inpatient, ED) to clarify the context of care.
7. If applicable, check ‘WSIB’ and provide the WSIB number along with the date of injury.
8. Indicate the patient's mobility status and preferred language, ensuring any special considerations such as claustrophobia or need for interpretation are noted.
9. Review and check any risk factors that apply to the patient; this information is critical for assessors to know.
10. Complete the referring physician section, including name, address, and contact information.
11. Fill out any specific examination requests and clinical information needed for the imaging, along with related surgery and urgency status.
12. Include serum creatinine results and ensure they are within the required timeframe, along with other necessary information like height and weight.
13. Finalize by signing the form where indicated and ensure all required attachments such as previous imaging reports are included.
14. Once completed, users can save the changes made to the form, download or print the document, or share it as needed.

Ensure prompt submission of your completed CT requisition form online to facilitate scheduling and access to necessary imaging services.