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1245 16th Street Santa Monica Form

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Or other Allergies:________________________ Primary Diagnosis: __________________________________________________ICD9:__________________ Pertinent clinical history _____________________________________________________________________ _________________________________________________________________________________________ Purpose of PET/CT Initial Treatment Strategy Subsequent Treatment Strategy Please specify one: Please select the appropriate procedure: PET/CT (base of skull to upper thigh)...

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What is the 1245 16th Street Santa Monica

The 1245 16th Street Santa Monica form pertains to the services provided by UCLA Radiology located at that specific address. This facility offers various radiological services, including imaging and diagnostic procedures. Understanding the purpose of this form is essential for patients and healthcare professionals alike, as it may involve consent for procedures, insurance information, or other administrative details necessary for receiving care.

How to use the 1245 16th Street Santa Monica

Using the 1245 16th Street Santa Monica form involves several steps. Initially, patients should gather all necessary personal and medical information. This includes identification details, insurance information, and any relevant medical history. Once the form is filled out, it can be submitted electronically or in person at the UCLA Radiology facility. Ensuring that all information is accurate and complete is crucial for a smooth processing experience.

Steps to complete the 1245 16th Street Santa Monica

Completing the 1245 16th Street Santa Monica form requires careful attention to detail. Follow these steps:

  • Gather required documents, such as identification and insurance cards.
  • Fill out personal information, including name, address, and contact details.
  • Provide medical history relevant to the radiological services needed.
  • Review the form for accuracy before submission.
  • Submit the form electronically or deliver it in person to the UCLA Radiology office.

Legal use of the 1245 16th Street Santa Monica

The legal use of the 1245 16th Street Santa Monica form involves compliance with healthcare regulations and patient rights. This form must be completed accurately to ensure that the patient's consent is valid for the procedures performed. Additionally, it should comply with HIPAA regulations to protect patient privacy and confidentiality. Understanding these legal implications is vital for both patients and healthcare providers.

Key elements of the 1245 16th Street Santa Monica

Key elements of the 1245 16th Street Santa Monica form include:

  • Patient's personal information and contact details.
  • Insurance information and policy numbers.
  • Details of the radiological services being requested.
  • Informed consent section for procedures.
  • Signature line for patient acknowledgment.

Form Submission Methods (Online / Mail / In-Person)

The 1245 16th Street Santa Monica form can be submitted through various methods, ensuring flexibility for patients. Options include:

  • Online submission via the UCLA Radiology patient portal.
  • Mailing the completed form to the facility's address.
  • Hand-delivering the form to the office at 1245 16th Street, Santa Monica.

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Related links to 1245 16th Street Santa Monica
Santa Monica-UCLA Medical Center

Santa Monica-UCLA Medical Center. Provider Number. W11817A. Date Approved. 2007-01-12. Address. 1245 16th Street, Ste 105. Santa Monica, CA 90404. United States.Read more

Best Bed and Breakfasts in California

The Carter House is the largest building of the inns, followed by the Hotel Carter, which is across the street. The hotel has the largest amount of rooms and ...Read more

UCLA Health Imaging Locations

2020 Santa Monica Blvd. Suite 210 (2nd floor) Santa Monica, CA 90404 ... 1245 16th St #100. Santa Monica, CA 90404. Walk-In XR: 7:00AM - 12PM, 1PM - 8 ...Read more

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