WA Radiology Imaging Request Form Instructions
This file contains instructions and forms necessary for ordering radiology imaging. It includes details for routine and urgent exams, necessary steps for CT scans, MRIs, and biopsies requiring radiological review. Follow the guidelines provided for timely and accurate processing.
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How do I fill this out?
To fill out this form, you will need the patient's details, diagnostic codes, and the specifics of the requested imaging. Ensure all necessary information such as the patient's emergency contacts and any additional required tests are included. Provide complete and legible information to avoid delays.
How to fill out the WA Radiology Imaging Request Form Instructions?
1
Gather patient information, including name, contact details, and medical history.
2
Specify the imaging requests and provide diagnosis codes (ICD) and symptoms.
3
Include details of the ordering provider and clinic contact information.
4
Provide emergency contact numbers if results need to be relayed urgently.
5
Submit the completed form via fax to the Radiology Appointing Center.
Who needs the WA Radiology Imaging Request Form Instructions?
1
Physicians who need to order radiology imaging for patient diagnosis.
2
Radiology departments to process and schedule imaging requests.
3
Patients who have been ordered an imaging exam and need to provide information.
4
Healthcare providers coordinating patient care and requiring imaging results.
5
Clinics and hospitals submitting medical records for radiology review.
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What are the instructions for submitting this form?
To submit this form, complete all required fields and ensure the information is clear and legible. Send the completed form via fax to 844-660-0675. If there are any urgent imaging requests, mark the form as 'emergent' and expect processing within 24 hours. Contact the Radiology Appointing Center at 1-877-751-4284 if the patient is not contacted within 24 hours for urgent requests. For routine exams, the form will be processed within 48 hours.
What are the important dates for this form in 2024 and 2025?
Routine exams will be processed within 48 hours, and urgent exams are processed within 24 hours. Biopsy and Interventional Radiology requests should include medical records.
What is the purpose of this form?
The WA Radiology Imaging Request Form is essential for healthcare providers to order radiology imaging such as MRIs, CT scans, and biopsies. This form ensures all relevant patient information, imaging details, and diagnostic codes are properly documented for accurate and timely processing. By following the provided guidelines, healthcare providers can ensure that patients receive necessary imaging services promptly and efficiently.
Tell me about this form and its components and fields line-by-line.
- 1. Member Number: The patient's unique identification number.
- 2. Patient Name: Full name of the patient requiring the imaging.
- 3. Phone Number: The best contact number for the patient.
- 4. DOB: Patient's date of birth.
- 5. Imaging Requested: Specific details of the imaging needed, including type and area to be imaged.
- 6. Diagnosis Code (ICD): The ICD code corresponding to the patient's diagnosis.
- 7. History/Symptoms: Brief description of the patient's medical history and current symptoms.
- 8. Ordering Provider: Name and title of the healthcare provider ordering the imaging.
- 9. Clinic Name: Name of the clinic or hospital where the ordering provider is based.
- 10. Clinic Contact: Contact information of the clinic or hospital.
- 11. Tax ID Number: Clinic or healthcare provider's tax identification number.
- 12. Specialty: The specialist field of the ordering provider.
- 13. Emergency Number: Contact number for urgent communication.
What happens if I fail to submit this form?
If you fail to submit this form, there could be delays in scheduling the patient's imaging appointment.
- Scheduling Delays: Delayed processing of the imaging request due to incomplete form.
- Incomplete Information: Risk of imaging errors or missing critical information necessary for patient diagnosis.
- Return of Form: Form returned for correction, leading to further delays.
How do I know when to use this form?
- 1. Routine Imaging: For routine imaging services needed for patient diagnosis.
- 2. Urgent Imaging: When the imaging needs to be done within three business days.
- 3. Biopsy and Interventional Radiology: For submitting biopsy and interventional radiology requests along with medical records.
- 4. CT Scans: For requesting CT scans, especially with IV contrast for patients over 50 years.
- 5. MRI Requests: For all MRI requests, which must be reviewed by a radiologist.
Frequently Asked Question
How do I fill out the radiology request form?
Fill out the patient's information, specify the imaging requested, include diagnosis codes, and ensure the ordering provider’s details are completed.
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What information is needed for the radiology request form?
You need the patient's personal info, details of the imaging request, diagnosis codes, symptoms, and the ordering provider's contact information.
How do I ensure my form is correctly submitted?
Ensure all required fields are completed legibly and submit the form via the provided fax number.
What happens if my form is incomplete?
Incomplete or illegible forms will be returned, causing delays in scheduling the patient’s imaging appointment.
Can I submit the form online?
Currently, the form should be submitted via fax. Follow the submission instructions provided in the file.
When should I use the emergency contact section?
Use the emergency contact section if a radiologist needs to relay results urgently outside regular hours.
Where can I find additional forms like the MRI Questionnaire?
Additional forms like the MRI Questionnaire are available on the Kaiser Permanente provider website.
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