Get Nyu Hospitals Center Clinical Cancer Center - Nyu Langone ... - Med Nyu

This guide provides clear instructions for efficiently completing the NYU Hospitals Center Clinical Cancer Center form for a PET/CT exam. Users will benefit from a step-by-step walkthrough designed to clarify each section of the form for online submission.

Follow the steps to complete your form accurately.

1. Press the ‘Get Form’ button to access the PET/CT exam request form and open it in your preferred document editor.
2. Begin by entering the patient demographics. This includes the patient's name, date of birth, age, phone number, MR number, height, and weight.
3. Indicate whether the patient has diabetes by selecting the appropriate option: Yes, No, IDD, or NIDD.
4. Provide information about the patient's medical history. Enter details regarding past radiation therapy, chemotherapy, surgery dates, and chemotherapy types.
5. If applicable, evaluate treatment response by selecting Yes or No. Ensure to fax any relevant Radiology or Lab reports.
6. Complete the section on the PET/CT exam type. Check the appropriate exam(s) based on the patient's diagnosis, including options such as brain tumor imaging, breast cancer, cervical cancer, and more.
7. Fill out the requesting physician's information, including their printed name, telephone number, signature, and date.
8. Review the entire form for accuracy and completeness before finalizing.
9. Once completed, users can save changes, download, print, or share the form as needed.

Complete your PET/CT exam request form online today for a streamlined processing experience.