Follow the steps to fill out the CA Stockton Diagnostic Imaging Request online:

1. Click the ‘Get Form’ button to access the CA Stockton Diagnostic Imaging Request. This will allow you to open the form in an online editor where you can easily fill it out.
2. Enter the appointment date, time, and today’s date accurately in the designated fields.
3. Provide the patient’s name and date of birth in the respective fields to ensure proper identification.
4. In the clinical history/reason for the exam section, write a clear and concise description of the medical necessity for the imaging request.
5. Fill out the insurance information by specifying the insurance provider and the patient's phone number.
6. Enter the referring physician's name, along with their signature, phone number, and fax number to authenticate the request.
7. Mark the appropriate boxes for any previous imaging, reports, and results required, indicating the method of communication preferred.
8. Select the type and details of the imaging needed by checking the relevant boxes. This includes options for different modalities such as MRI, CT, PET/CT, and Ultrasound.
9. If applicable, include any specific procedures or examinations requested, detailing any special attention required.
10. Once all sections are completed, review the information for accuracy, then save your changes. You may then download, print, or share the completed form as needed.

Complete your CA Stockton Diagnostic Imaging Request online today and ensure a smooth preparation for your upcoming imaging appointment!