Mammogram order form 2025

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The document is a Mammography Order Form from Future Diagnostic Group located in Joliet, IL. It collects patient information, insurance details, and specifies the type of mammogram requested (screening or diagnostic) along with relevant medical history and ICD-10 codes. The form also includes instructions regarding prior mammograms and necessary preparations for the exam.

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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.

Can I request my mammogram images?

Always get your own copies of imaging. Any time you have an imaging test (such as a mammogram, ultrasound, MRI, PET scan, CAT scan, or X-ray), ask the technician or nurse right away for the films or a digital copy on a CD or flash drive.

Can you just ask for a mammogram?

Doctors orders You can ask your primary care doctor or gynecologist to help you find a facility to get a mammogram and for a doctors order for a mammogram. You may not need a doctors order if youre 40 or older and getting an annual screening mammogram.

Do I need a doctors order to schedule a mammogram?

Did you know you dont need a referral, prescription or order form from your doctor to get a mammogram? Women over 40 who are not experiencing symptoms can make an appointment for their annual mammogram on their own.

How to get a mammogram ordered?

You need a doctor or doctors order to schedule this exam. If you are scheduling an appointment with a doctor for the first time, be sure to tell the scheduler that you have an abnormal symptom.

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