How to use or fill out the X-ray and Imaging Outpatient Order Form
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, date of birth, and contact numbers. Ensure all fields are completed for a smooth process.
- Next, move to the 'Physician Information' section. Input the referring practitioner's last name, first name, NPI number, fax number, and signature along with the date.
- In the 'General Radiology' section, select the appropriate tests by marking 'R', 'L', or 'B' for each body part as needed.
- Finally, provide any relevant signs & symptoms or diagnosis in the designated area. Be specific for each test ordered to avoid confusion.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2009 | 4.8 Satisfied (264 Votes) |
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