FAX Cover Sheet - The Queen's Health Systems 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'To' section with the recipient's details, specifically the Imaging Department MRI Scheduler.
3. In the 'From' section, enter your name and contact information, including your fax number and telephone number.
4. Specify the date and time of sending, along with the total number of pages being sent, including the cover page.
5. Complete the patient information fields: Patient Name, Date of Birth, and Phone Number. Ensure accuracy for proper identification.
6. Fill in the subject line with 'MRI Exam Order' and provide a written diagnosis along with ICD-9 codes as required.
7. Indicate any prior relevant images or documents included with this fax by checking appropriate boxes.
8. Review all sections for completeness before sending. Use our platform’s features to save or print a copy for your records.

Start using our platform today to streamline your document editing and ensure efficient communication!