Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the AU Monash Health 173712 form and open it for editing.
2. Fill in the patient name and demographic details, including date of birth, gender, and address. Ensure all personal information is accurate.
3. Provide the appointment date and time in the designated sections. If an interpreter is required, select 'Yes' and specify the language.
4. Complete the referring consultant details by entering the name, provider number, contact information, and any additional recipient information for report copies.
5. In the clinical details section, indicate the reason for the PET scan by selecting from the provided options or specifying 'Other' if necessary.
6. Input relevant clinical staging and scores, including the Gleason score and recent PSA level, to provide necessary medical context.
7. Document previous surgeries or treatments, including dates and types of therapies administered. If additional clinical history is applicable, include that information as well.
8. In the assessment request section, specify if additional imaging is required and indicate the urgency of PET results.
9. Ensure the signature of the consultant/specialist is added in the designated location, along with the current date for verification purposes.
10. Review the completed form for accuracy. Once finalized, you can save the changes, download, or print the form, or proceed to share it as required.

Complete the AU Monash Health 173712 form online to ensure a seamless process for your PET scan request.