Ultrasound Order Form - Department of Obstetrics and Gynecology 2025

Get Form
Ultrasound Order Form - Department of Obstetrics and Gynecology Preview on Page 1

Here's how it works

01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Ultrasound Order Form - Department of Obstetrics and Gynecology with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the Ultrasound Order Form in the editor.
  2. Begin by entering the patient's name, date of birth, and contact information in the designated fields. Ensure all required fields are filled out accurately.
  3. Indicate if an interpreter is needed by checking the appropriate box and specifying the language if applicable.
  4. Fill in insurance details including the insurance name, policy holder's name, policy ID, and group number. This information is crucial for processing referrals.
  5. Select the preferred scan location from the options provided. If applicable, indicate whether the patient is inpatient.
  6. Specify the indication for referral by selecting from options such as Gynecologic or Obstetric Ultrasound and provide relevant details like LMP and EDC.
  7. Complete any additional sections related to diagnostic testing or genetic counseling as necessary.
  8. Finally, ensure that a physician signature is included along with the date before submitting the form.

Start using our platform today to streamline your form completion process for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
An ultrasound order, is essentially a prescription or referral from a healthcare provider requesting an ultrasound examination for a patient. This order outlines the medical necessity for the ultrasound procedure and provides pertinent information for the radiologist or sonographer performing the scan.
During pregnancy, your obstetrician will order or perform routine ultrasounds for a number of reasons, but they are done primarily to assess the growth and development of your baby.
The obstetric ultrasound report should include 3 essential components: basic information about the pregnancy, fetal biometric measurements and fetal anatomic details.
Ultrasound Guidance The documentation should clearly indicate the type of procedure, the specific anatomical location of the images, the specific anatomic structures visualized, and a documented description of the localization process. This information is critical to ensure that the service is accurately reported.