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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Appointment Date' and 'Check-in Time' in the designated fields. This information is crucial for scheduling your visit.
Select your preferred location by checking one of the boxes: Port Orchard, Bremerton, Poulsbo, or Silverdale.
Fill in the 'Date of Referral' and provide the 'Referring Provider Name.' Ensure that you obtain a signature from the referring provider in the specified area.
Complete your personal details including 'Patient Name,' 'Best Phone,' 'Height,' and 'Weight.' Indicate if you are pregnant.
In the section for insurance details, enter your insurance provider and authorization number. Provide a written diagnosis or reason for the exam as required.
Select any necessary imaging procedures from the list provided, ensuring to specify any additional details where indicated.

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Do I need an order for imaging?

An encounter for radiology services begins with a test order from the treating physician, commonly called the referring physician. The order is taken to an imaging center, hospital, or other provider of diagnostic imaging services.

Is diagnostic imaging covered by insurance?

Insurance Plans and Imaging Coverage Most major insurance providers, including Aetna, Blue Cross Blue Shield, UnitedHealthcare, and Cigna, cover imaging tests. Government plans, such as Medicare and Medicaid, also typically include coverage for medical imaging.

What do I do with an imaging order?

After you receive confirmation your insurance accepted the referral, you can go ahead and request an appointment at an imaging testing facility. Your doctors order can help you get a scan when needed. The timing for your CT scan, MRI or x-ray depends on the imaging centers schedule.

What is a diagnostic imaging order?

With a diagnostic screening, which may include tests such as X-ray or magnetic resonance imaging (MRI), your doctor can actually see the structures inside your body, offering them clues about what is causing your symptoms.