Uchealth imaging form 2026

See details

4.1 out of 5

43 votes

The document is a Radiology Imaging Request Form that outlines the necessary information and requirements for ordering imaging services. It includes sections for patient and insurance information, imaging orders, diagnosis codes, and specific instructions for sedation and Medicare documentation. Additionally, it emphasizes the need for supporting medical necessity documents to avoid treatment delays.

Here's how it works

01. Edit your uchealth request form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out uchealth imaging form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the uchealth imaging form in the editor.
Begin by filling out the Patient Information section. Enter the patient's name, date of birth, gender, address, city, state, zip code, and phone number.
Next, provide Insurance Information. Include the member/provider services phone number, insurance provider name, member ID, and group ID.
In the Imaging Order section, select the appropriate imaging type by checking the relevant boxes for CT, MR, Nuclear Medicine, XRAY/Fluoro, Ultrasound, or PET/CT Scan. Specify any contrast requirements if applicable.
Fill in Diagnosis Codes and Laterality options (Left, Right, Bilateral) as needed.
Indicate if the patient is claustrophobic and select any sedation options required for the procedure.
Complete the Referring Provider Information section with your name (printed), NPI number, contact details, and signature along with the date.
Finally, choose the appropriate UCHealth imaging facility region for submission.

Start using our platform today to easily complete your uchealth imaging form online for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to access medical imaging?

Your image files are typically stored at the facility where you had your exam. When you request your medical images, you will need to sign a release form. The images will typically be available as: printed photos (also known as radiology films).

How to get results from American Health Imaging?

How does it work? Receive a text message 48 hours after your image report is finalized. Review your report, learn about your condition, and prepare to meet with your doctor to discuss next steps. View anytime on your computer or mobile device.

How to prepare for medical imaging?

You should wear comfortable, loose-fitting clothes. You should not eat for four hours before the scan and you will be encouraged to drink water (especially if your test involves evaluation of the stomach or kidneys). Your doctor will instruct you regarding the use of medications before the test.

How do I get into medical imaging?

Graduating from a two-year radiologic technology program typically qualifies you to sit for The American Registry of Radiologic Technologists (ARRT) radiography exam. Passing this exam earns you the title of registered radiologic technologist certified in radiography, which is the most common route into the profession.