Get Sutter Imaging Smf-694 2019-2025

Filling out the Sutter Imaging SMF-694 form online can be a straightforward process when guided correctly. This guide provides a comprehensive step-by-step approach to ensure that all necessary information is accurately presented.

Follow the steps to complete the Sutter Imaging SMF-694 online form

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the patient's name in the designated field, followed by their date of birth (DOB). Input the patient's phone number to ensure they can be reached if necessary.
3. Select the type of exam being requested from the options provided: MRI, CT, US, NUCMED, XRAY, or FLOURO. Make sure to highlight the correct exam.
4. Document the diagnosis along with the associated ICD 10 code in the respective fields to specify the medical issue being addressed.
5. Fill out the patient's medical history and include any special instructions or additional exams required in the allocated sections.
6. Enter the patient's identification (ID) number and insurance information, including the insurance carrier, medical group, and the insurance phone number.
7. If applicable, provide the authorization number for the insurance carrier by typing it into the appropriate field.
8. Print the name of the ordering provider and ensure the signature is entered, followed by the provider's date, phone number, and fax number.
9. Specify the locations to which reports should be sent by providing names and locations in the designated area.
10. Review all entered information for any errors, then proceed to save changes, download, print, or share the completed form as needed.

Complete your Sutter Imaging SMF-694 form online today for a smoother imaging process.