Get Radiology Procedure Order Form

Completing the radiology procedure order form online is a crucial step in preparing for your medical imaging appointment. This guide will walk you through each section of the form to ensure that all necessary information is provided accurately and efficiently.

Follow the steps to complete the online radiology procedure order form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Enter the patient's name, date of birth, phone number, and alternate phone number in the designated fields.
3. Specify the appointment date and time, ensuring that it aligns with your scheduling needs.
4. Provide information regarding the patient's insurance, making sure all details are accurate.
5. In the 'Procedure Requested' section, select the imaging procedure(s) that are being ordered, such as CT, MRI, or X-Ray, by checking the appropriate box.
6. Indicate if contrast is required for the procedure by selecting 'Yes' or 'No'. If 'Yes', continue providing necessary details.
7. Respond to the questions regarding the patient's health, including if they are pregnant, claustrophobic, or have any risk factors such as hypertension or kidney disease.
8. Complete the sections concerning contrast allergies, weight, and height, ensuring to provide any relevant medical history.
9. Write the ICD-9 code and relevant clinical history, if available, in the specified field.
10. Fill out the attending physician's name, and provide the ordering physician's signature, pager, or contact number, along with the date and time of submission.
11. Review all entries for accuracy, then save changes, download, print, or share the completed form as necessary.

Begin filling out your radiology procedure order form online to ensure a smooth appointment process.