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Get Duke University Health System Cardiac Mri Request Form 2008
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How to fill out the Duke University Health System Cardiac MRI Request Form online
This guide provides clear instructions on how to complete the Duke University Health System Cardiac MRI Request Form online. By following these steps, users can efficiently submit their request for a cardiac MRI.
Follow the steps to complete your online form submission.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering the 'Date' in the appropriate field to indicate when the request is being made.
- Fill in the 'Location' section to specify where the MRI is to be scheduled.
- Select the 'TIME' for the MRI from the available options, noting which locations are available (North or South).
- Enter the 'Date of Referral', 'Patient Name', 'MRN', and 'DOB' to provide the necessary patient information.
- Include the 'Patient Phone' number for any necessary follow-up communication.
- Specify the 'Referring/Requesting MD' and their 'Contact Information' to ensure proper handling of the request.
- Select the appropriate 'CPT Code' for the MRI procedure being requested, based on the clinical needs.
- Choose the type of 'Study' required from the options available on the form.
- Fill in the 'Clinical Indication for Exam' by providing relevant ICD-9 codes to support the request.
- Answer the questions regarding the patient's medical history, such as metal in eyes, potential pregnancy, and weight considerations, as well as sedation needs.
- Add any additional 'COMMENTS' or special instructions specific to the MRI request.
- Obtain the required physician signature to authorize the request.
- Once all fields are completed, save changes, then download, print, or share the form as needed.
Complete your Duke University Health System Cardiac MRI Request Form online today!
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Cardiac magnetic resonance imaging (MRI) uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within and around the heart. Doctors use cardiac MRI to detect or monitor cardiac disease.
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