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Breast imaging services mammography order form 2026

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The document is a Mammography Order Form for Breast Imaging Services at Lake Forest Hospital, detailing patient information requirements, types of mammograms (screening and diagnostic), and instructions for the exam day. It includes contact information, scheduling details, and locations for various imaging centers associated with the hospital.

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Click ‘Get Form’ to open the breast imaging services mammography order form in the editor.
Begin by entering the patient information. Fill in the last name, first name, middle initial, date of birth, and social security number. Ensure accuracy for seamless processing.
Select the type of mammogram required: Screening or Diagnostic. For a Screening Mammogram, check the appropriate box and provide today’s date. If opting for a Diagnostic Mammogram, indicate any symptoms or reasons for this choice.
Provide contact details including daytime telephone number and email address to facilitate communication regarding appointments.
Indicate which breast(s) require examination by selecting Left, Right, or Bilateral options. If there are specific areas of concern, mark them on the provided graphic.
If additional procedures like Breast Ultrasound or Core Biopsy are needed, select those options and provide reasons as necessary.
Finally, ensure that a physician's signature is included before submitting the form for processing.

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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 get a copy of my mammogram?

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 see mammogram images on MyChart?

Beginning 1/18/2024, patients will have access to view and download both current and historical Radiology Imaging studies. 1. Log in to your MyChart account. From the home page, click Test Results in the toolbar.

Can I schedule a mammogram without a doctors order?

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. Annual mammograms are the best tool for early detection of cancer.

Can I request my mammogram images?

If you also want copies of the mammogram images and the more technical written summary that is sent to your doctor, you may need to ask for them. They may not be provided to you unless you ask.

Can you request an ultrasound over a mammogram?

Women for whom mammography cannot be performed for any reason may benefit from ultrasound screening, such as women over age 40 with disability impacting the ability to cooperate with mammographic positioning.

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Is a imaging exam the same as a mammogram?

First, a ultrasound is not a replacement screening tool for a mammogram but can be conducted in addition to an annual mammogram if a patient has abnormal results. A mammogram uses a low dose of radiation to form comprehensive images, whereas an ultrasound uses sound waves to create an image.

Why would my doctor ask for additional images from mammogram?

You could be called back after your mammogram because: The pictures werent clear or didnt show some of your tissue, so they need to be retaken. The radiologist (doctor who reads the mammogram) sees something suspicious, such as calcifications or a mass (which could be a cyst or solid mass).

How do you 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.

Breast imaging services mammography order form 2026

Here's how it works

How to use or fill out breast imaging services mammography order form with our platform

See more breast imaging services mammography order form versions

Complete this form in 5 minutes or less

Got questions?

Can I get a copy of my mammogram?

Can you see mammogram images on MyChart?

Can I schedule a mammogram without a doctors order?

Can I request my mammogram images?

Can you request an ultrasound over a mammogram?

Security and compliance

Complete this form in 5 minutes or less

People also ask

Is a imaging exam the same as a mammogram?

Why would my doctor ask for additional images from mammogram?

How do you get a mammogram ordered?

breast imaging services mammography order form

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