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Request for Diagnostic Imaging Process Flowchart Example
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Imaging Request: Form Completion
A brief process overview Gather patients name and verify identification Answer any additional questions the patient may have Physician signs off on the request form MD to select diagnosis by using the codes listed MD reviews patient records to complete diagnosis Record Clinical indications for the exam Is the study listed on the form? Select which study is being performed Imaging request form generated by MD or PA Get contact information for nearest friend or relative Patient is transferred to front office for form completion Verify patients insurance, get prior authorization if applicable Fill in personal info including weight, D.O.B, and phone number Date of examination Pre/Post Op? Give patient confirmation of their appointment Send request over to Radiology Ward Schedule a date and time for the imaging request to be performed Receive test schedule from Radiology Ward Record office information/where this report will need to be sent back to Date of Surgery Specify the study to be performed in the box below
A brief process overview Gather patients name and verify identification Answer any additional questions the patient may have Physician signs off on the request form MD to select diagnosis by using the codes listed MD reviews patient records to complete diagnosis Record Clinical indications for the exam Is the study listed on the form? Select which study is being performed Imaging request form generated by MD or PA Get contact information for nearest friend or relative Patient is transferred to front office for form completion Verify patients insurance, get prior authorization if applicable Fill in personal info including weight, D.O.B, and phone number Date of examination Pre/Post Op? Give patient confirmation of their appointment Send request over to Radiology Ward Schedule a date and time for the imaging request to be performed Receive test schedule from Radiology Ward Record office information/where this report will need to be sent back to Date of Surgery Specify the study to be performed in the box below