Interventional radiology requisition 2026

1. Click ‘Get Form’ to open the interventional radiology requisition in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's MRN, date of birth, health card number, and personal details such as last name, first name, and contact numbers.
3. Indicate any special needs under 'Interpreter' and 'Restricted Mobility'. Select the payment method and gender identity options as applicable.
4. In the 'Exam Information' section, specify the date of request and detail the exam requested along with relevant clinical information.
5. Complete the 'Medical History' section by checking off any relevant medical conditions and allergies. Provide details about medications being taken.
6. Fill in the 'Blood Work' section with required test results ensuring they are within 30 days of appointment scheduling.
7. Finally, ensure that both referring physician and radiologist signatures are obtained in the 'Signature' section before submission.

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