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CARDIAC DIAGNOSTICS REQUISITION - wdmh.on.ca - wdmh on 2026

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The document is a requisition form for cardiac diagnostics services, including ECG, treadmill tests, Holter monitors, echocardiograms, and carotid ultrasounds. It provides space for patient information, test indications, and physician details. The form outlines various tests available for diagnosing heart conditions and includes instructions for patients regarding preparation and procedure duration.

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Click ‘Get Form’ to open the CARDIAC DIAGNOSTICS REQUISITION in the editor.
Begin by entering the patient's name, address, and contact information in the designated fields. Ensure accuracy for effective communication.
Select the appropriate options for patient type (Out Patient or ER/In Patient) and indicate any isolation requirements if applicable.
Fill in the date of birth and OHIP number. This information is crucial for identification and billing purposes.
Choose the tests required by checking the relevant boxes such as ECG, Treadmill Exercise Test, Holter Monitor, etc., based on the patient's symptoms.
Provide additional details regarding indications for tests in the space provided to ensure comprehensive assessment.
Complete the referring physician's information and ensure all required signatures are obtained before submission.

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