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Click ‘Get Form’ to open the cardiac cta worksheet form in the editor.
Begin by entering the patient's birthdate, name, registration number, and visit number at the top of the form. This information is essential for identifying the patient.
Fill in the order date and appointment information, including the date, day, and time of the appointment. Ensure accuracy to avoid scheduling issues.
In the 'REASON(S) FOR CT SCAN' section, check all applicable boxes that describe why the scan is needed. Provide additional details where necessary, such as symptom types.
Complete the LAB RESULTS section by entering relevant lab data from within the past 30 days. Indicate if the patient is taking a beta-blocker and any known contraindications.
Finally, review all entries for completeness and accuracy before saving or submitting your form through our platform.

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How long does a CTA of the heart take?

18 to 24 hours before your appointment, take nothing by mouth (except for water). If you have diabetes, do not take any diabetic medication after midnight the evening before your scan. All other medications may be taken. Only plain water is permitted; flavored water is not allowed.

What are the instructions for a cardiac CTA scan?

Do not take energy pills or diet pills on the day before or the day of your scan. On the day of your scan, do not eat for 4 hours before your scan. During this time, you may drink clear liquids that do not contain caffeine. Plan to arrive at Imaging Services 1 hour before your scan is scheduled to start.

Can I eat or drink before a CT scan of my heart?

Usually, a CT coronary angiogram requires not eating anything for at least 8 hours before the test. Drinking water is OK. Dont have drinks that contain caffeine 12 hours before. Caffeine can raise the heart rate, making it hard to get clear pictures of the heart.

What is the difference between 75573 and 75574?

Does that mean that 75571 through 75573 are just computed tomographic (CT) heart only codes with no angiography? Answer: Yes, that is correct. Code 75574 is the only cardiac CT angiography code in the cardiac CT/CTA code series.

How do you prep for a cardiac CTA?

This exam may require you to drink an oral contrast solution. If you are undergoing a chest/cardiac CTA, do not consume any caffeine or exercise three hours prior to your appointment. No erectile dysfunction medication for 48 hours before your test.

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Got questions?

How long does a CTA of the heart take?

What are the instructions for a cardiac CTA scan?

Can I eat or drink before a CT scan of my heart?

What is the difference between 75573 and 75574?

How do you prep for a cardiac CTA?

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Cardiac cta worksheet form 2026

Here's how it works

How to use or fill out cardiac cta worksheet form with our platform

See more cardiac cta worksheet form versions

Complete this form in 5 minutes or less

Got questions?

How long does a CTA of the heart take?

What are the instructions for a cardiac CTA scan?

Can I eat or drink before a CT scan of my heart?

What is the difference between 75573 and 75574?

How do you prep for a cardiac CTA?

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