Get Uscf 108-0005 2009-2025

The USCF 108-0005 form is essential for scheduling radiology appointments and ensuring accurate information for patient care. This guide will provide clear instructions on how to complete this form efficiently using the online platform.

Follow the steps to complete the USCF 108-0005 form online:

1. Click the ‘Get Form’ button to access the USCF 108-0005 form and open it in your browser or editor.
2. Begin by entering the patient's creatinine level and the date in the specified fields.
3. Fill in the patient appointment details, including date, time, and location. If it is a STAT request, select ‘Yes’ or ‘No’ in the designated box.
4. Indicate the patient's pregnancy status and prior contrast reaction by checking ‘Yes’ or ‘No’.
5. If the patient has impaired renal function, mark ‘Yes’ or ‘No’ accordingly.
6. In the patient information section, either affix a UCSF sticker or enter the patient's name, date of birth, medical record number, and phone numbers.
7. Complete the referring physician information, including their name, contact person, phone, pager, and fax number.
8. Provide the diagnosis or clinical indications and the UC attending physician ID. Ensure the medical doctor’s signature is included where required.
9. Carefully check the box for the exam requested and complete any additional required sections according to the type of radiology exam.
10. Review all information entered on the form, and once satisfied, save your changes, then download, print, or share the form as needed.

Start filling out your USCF 108-0005 form online now!