Get For Contract Type 6 Usbx Breast Diagnostic Evaluation, Ultrasound & Radiological Biopsy

This guide provides a clear and supportive overview of how to fill out the For Contract Type 6 USBX Breast Diagnostic Evaluation, Ultrasound & Radiological Biopsy form online. By following the detailed instructions, users can ensure that all necessary information is accurately provided.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the document and open it in the designated editor.
2. Carefully review the scope of services outlined in the form. Ensure that you understand the patient eligibility requirements, including age and insurance status.
3. Fill in the patient’s information, including name, contact details, and relevant medical history related to breast abnormalities.
4. Complete the section for diagnostic evaluation by providing any available mammography results and ultrasound reports that pertain to the patient.
5. Document any referrals for diagnostic mammography as instructed, ensuring to include a written order stating the patient’s association with the Best Chance Network.
6. Include details of any performed procedures, such as breast cyst aspirations or biopies, along with the necessary clinical outcomes.
7. Fill out the referral section, ensuring proper documentation of attempts to follow up with patients with abnormal findings.
8. Provide information about the facility providing the services and the staff involved, confirming that all personnel have appropriate professional credentials.
9. Submit the completed Provider Information Sheet to ensure that all information regarding service sites and contacts is up to date.
10. Finally, review all filled sections for accuracy before saving changes, printing, or sharing the completed form.

Complete your forms online to streamline processing and ensure timely care.