Get Hpj/nuk/001

This guide provides clear and supportive instructions on how to fill out the HPJ/NUK/001 PET/CT imaging request form online. Properly completing this form is crucial for the successful scheduling of a PET/CT scan.

Follow the steps to accurately complete the HPJ/NUK/001 form

1. Click ‘Get Form’ button to access the online version of the HPJ/NUK/001 form.
2. Fill in the patient's personal details, including their name, identity card number, date of birth, gender, ethnic group, age, contact number, and address. Ensure all fields are completed accurately.
3. Indicate relevant medical history by selecting 'Yes' or 'No' for conditions such as diabetes, claustrophobia, and drug allergies. If necessary, provide additional details about the patient's medical regime.
4. Complete the clinical diagnosis section, including the primary site of disease and the reason for the PET/CT study.
5. Detail relevant findings from clinical examinations, surgeries, histopathology, imaging, or other tests. Fill out all applicable fields and provide dates and additional details as needed.
6. Indicate whether the patient has undergone any treatments and provide details about the last treatment, including dates and treatment sites.
7. Select the clinical indication based on the patient's diagnosis and provide additional information for staging, such as T-stage, N-stage, and M-stage details.
8. Complete the disease status section indicating whether there is no evidence of disease, local recurrence, systemic disease, or equivocal findings.
9. State the intended management plan, indicating whether it is curative or palliative, and specify proposed management actions if PET is unavailable.
10. Fill in the referring consultant or specialist's details, including their name, title, hospital, signature, and telephone number. Ensure to provide a fax number and email address for communication.
11. Review all entries for accuracy and completeness before submitting. Once finalized, users can save changes, download, print, or share the form as needed.

Complete your HPJ/NUK/001 document online today to ensure timely scheduling of your PET/CT scan.