Diagnostic imaging order 2026

1. Click ‘Get Form’ to open the diagnostic imaging order in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields. This information is crucial for identifying the patient.
3. Select the type of exam requested by checking the appropriate box (MRI, CT, US, NUCMED, XRAY, FLOURO). Ensure that you choose only one option.
4. Fill in the diagnosis and ICD 10 code in their respective fields. This helps in providing accurate medical information for processing.
5. Provide any relevant patient history and special instructions or additional exams needed. This section allows for personalized care.
6. Complete the insurance details including carrier, phone number, and authorization number. Attach a copy of the insurance card as required.
7. The ordering provider must sign and print their name along with the date. Include contact information such as phone and fax numbers.
8. Lastly, specify where to send reports by listing names and locations in the provided space.

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