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How to use or fill out 3375 (F) 860 with our platform
- Click ‘Get Form’ to open the 3375 (F) 860 in the editor.
- Begin by entering the patient's name, date of birth, and weight in the designated fields. Ensure accuracy as this information is crucial for scheduling.
- Fill in the contact numbers and indicate if the patient has claustrophobia by selecting 'Yes' or 'No'.
- Provide insurance details including primary and secondary insurance names along with their respective ID numbers.
- Complete the authorization sections as required, ensuring that all necessary authorizations are obtained prior to the appointment.
- Specify the exam requested and list any signs or symptoms using ICD-10 codes. Be detailed to avoid issues with insurance claims.
- Select the anatomical area and procedure type from the options provided, ensuring you check all relevant boxes.
- Finally, have the referring MD print their name and sign where indicated before submitting the form.
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