Get Lake Forest Hospital Breast Imaging Services Mammography Order Form 2008-2026
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How to fill out the Lake Forest Hospital Breast Imaging Services Mammography Order Form online
Completing the Lake Forest Hospital Breast Imaging Services Mammography Order Form online is essential for ensuring you receive the appropriate imaging services. This guide offers clear instructions to assist you in accurately filling out each section of the form with ease.
Follow the steps to easily complete the order form online.
- Click ‘Get Form’ button to access the order form and open it in the editor.
- Fill in the patient information section, including last name, first name, middle initial, and date of birth. Ensure that the information matches the patient's official documents for accuracy.
- Indicate the type of mammogram required: Screening or Diagnostic. If it is a Screening Mammogram, check the relevant box. If it is a Diagnostic Mammogram, provide the reason for the procedure, including any symptoms or concerns.
- Provide the patient's social security number, daytime telephone number, and email address. This information will assist in communication regarding the imaging appointment.
- Enter the referring physician's information, including name, office telephone number, and fax number, to ensure proper coordination of care.
- Please note additional instructions provided regarding preparation for the exam, including avoiding the use of powder, deodorant, lotions, or perfume on the day of the exam.
- If applicable, indicate any specific areas of concern on the provided graphic of the breast. This may help guide the imaging process.
- Review all entered information for accuracy and completeness. Make any necessary corrections.
- Once the form is completed, save your changes, download, or print the form for submission. Consider sharing the form with the relevant healthcare providers as needed.
Complete the Lake Forest Hospital Breast Imaging Services Mammography Order Form online today to ensure timely access to your imaging services.
To get a copy of your mammogram, contact Lake Forest Hospital directly after your screening. They will guide you through the process of requesting your mammography records. You may need to fill out a form and provide some identification for security purposes. Keeping your health records organized is important for your ongoing care.
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