Get Uk Alliance Medical Imaging Request Form
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How to fill out the UK Alliance Medical Imaging Request Form online
Filling out the UK Alliance Medical Imaging Request Form online is an essential step in ensuring that your imaging appointment is processed smoothly. This guide will provide you with clear, step-by-step instructions to complete the form accurately and efficiently.
Follow the steps to complete the UK Alliance Medical Imaging Request Form online.
- Click the ‘Get Form’ button to access the form and open it in the editor.
- Input the patient details. This includes full name, date of birth, address, and contact information. Indicate whether the patient is male or female and note the start date of the last menstrual period, if applicable.
- Specify the method of patient arrival by selecting either 'Trolley' or 'Walking'. Indicate the funding source, choosing between NHS, Self Funded, or Private Patient. Provide information about any insurance arrangements, including the insurance company, membership number, and pre-authorization number, if known.
- Fill out the referral information section. Specify the reason for referral and select the imaging modality required (MRI, CT, X-ray, or Ultrasound) and the specific area to be imaged.
- Provide relevant medical history details in the designated section, including any previous surgeries, current medications, and the date and result of the most recent creatinine level test.
- Complete the safety check for MRI examinations. Answer the questions regarding pregnancy status, breastfeeding, any contraindications such as pacemakers or other implants, as well as diabetes status and allergy information.
- Fill in the referring clinician's details, including their name, address, contact number, and email. Ensure that the form is signed and dated by the referring clinician as required by regulations.
- After completing the form, review the entries carefully for accuracy. You can then save any changes made, download a copy of the form, or print and share it as needed.
Complete the UK Alliance Medical Imaging Request Form online today to ensure a hassle-free imaging experience.
To get an MRI without a doctor's order, you can submit the UK Alliance Medical Imaging Request Form. This user-friendly form allows you to bypass the traditional requirement for a doctor's order, making it easier to access the diagnostics you need. With this approach, you can take control of your health and seek immediate imaging services.
Fill UK Alliance Medical Imaging Request Form
Relevant previous medical history. Select your preferred date. Most centres require a minimum of 7 days advance notice. Please provide your permission for us to contact you with information, products or services that you request from us or which we feel may interest you. Egerton Road, Guildford, Surrey GU2 7XU. Overseas company address: Alliance Medical Diagnostic Imaging Ltd Portal Houseloughmore Avenue Raheen Business Park, Raheen, Limerick, Limerick V94fhx7. Fill out the form to request mobile MRI services. We appreciate your interest in our services and products and are happy to answer any questions you may have. Alliance Medical has been a trusted partner to the NHS for 30 years, providing diagnostic imaging solutions to patients throughout the UK. Fill out the form to request mobile MRI services.
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