Get Ct Scanner Confirmation And Charge Form

Filling out the CT Scanner Confirmation And Charge Form online can streamline the process of confirming and charging for scan services. This guide provides a clear, step-by-step approach to ensure that you accurately complete each section of the form.

Follow the steps to fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the 'To Be Completed by PI Applicant' section. Start by entering the project name and the principal investigator's full name. Ensure you provide accurate contact information including phone details and email addresses, followed by the department name.
3. Input the coordinator's name, along with the IRB or ACUC number, and its expiration date. Indicate whether the study is funded or unfunded by selecting the corresponding checkbox.
4. In the account section, fill in the Chartfield number accurately. Complete all required fields, including Fund, Department, Program, and Project ID.
5. By signing in the designated area, you acknowledge that the participant's informed consent is on file. Also, ensure you date your signature.
6. Proceed to fill out the participant or specimen information, including their name, ID, medical record number (MR #), account number (Acc #), date of birth (DOB), study ID, and study acrostic.
7. Provide the date and time of the scan, and specify the number of scans performed. Use the notes section for any additional information that may be required.
8. Complete the section for the CT research technologist. Document the type of scan completed and any applicable charges, along with room time, drugs or contrast used, and any veterinary or anesthesia notes.
9. The technologist should fill in their name and the date of completion, followed by their signature.
10. After completing all sections, make sure to save your changes. You may then download, print, or share the final version of the form as needed.

Start filling out the CT Scanner Confirmation And Charge Form online now for a seamless processing experience.