Get Breast Imaging Form - Columbiadoctors

This guide provides comprehensive instructions on how to effectively fill out the Breast Imaging Form for ColumbiaDoctors online. By following these detailed steps, users can ensure accurate and complete submission of their information.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Breast Imaging Form and open it in your preferred editor.
2. Begin by entering your full name and the date at the top of the form. Ensure that these fields are accurately filled out as this information is essential for identification.
3. Input your date of birth and age to assist medical staff in providing appropriate care and assessment.
4. List your physician's name and specify the recipient for the reports. Providing this information helps to ensure that the documentation reaches the appropriate healthcare provider.
5. Complete the contact information fields. Include your day and evening phone numbers, as well as your address. This ensures that the medical team can reach you if necessary.
6. Indicate whether you could be pregnant by checking 'Yes' or 'No'. Notify the technologist about your pregnancy status as it is pertinent to the imaging process.
7. Record how you prefer to be contacted if further communication is required.
8. Provide details regarding your last breast exam by your doctor, including the month and year.
9. Answer if you have had previous mammograms, along with the date and location if applicable. This information is vital for the best assessment and care.
10. Next, circle the option that applies to your routine breast history or any concerns, including lumps or prior breast-related medical procedures. Specify the side affected (right or left) where necessary.
11. Fill in the date of your last menstrual period and provide information on whether you have stopped having periods, including the age at which this occurred.
12. Indicate if you have had your ovaries removed and if you have had ovarian carcinoma by selecting 'Yes' or 'No'.
13. Discuss any hormone use by determining if you have ever used female hormones. Provide the ages if applicable and indicate current usage.
14. Detail your family history with breast cancer and ovarian carcinoma, including ages at which diagnoses were made.
15. Answer questions concerning any breast cancer treatments you have undergone, including mastectomy, lumpectomy, radiation, or chemotherapy.
16. Once you have completed all sections, review your responses for accuracy. Save your changes, and if necessary, download, print, or share the completed form as directed.

Complete your Breast Imaging Form online today for an efficient and straightforward process.