Outpatient Imaging Forms
Welcome to the Randolph Hospital Outpatient Center Imaging Forms page. At Randolph Hospital we take pride in serving our community. Within everything we do, we strive to ensure quality, positive patient experiences and value for everyone.
In an effort to ensure that our physician community is able to easily access the information and documents they need in order to serve their patients, Randolph Hospital has enabled the use of electronic outpatient imaging order forms. There are seven different forms based on the type of image/study needing to be ordered.
Please click on the form links and save them to your desktop so they can be easily accessed.
When needed, print the form, complete it and fax the order to the appropriate fax number listed on the form when you schedule the test.
Imaging Forms Available:
- CT Scan 2013
- MRI 2013
- Ultrasound 2013
- Nuclear Medicine 2013
- X-Ray 2013
- Labs 2013
- Mammograms 2013
- Other Tests 2013
(Other tests include Echocardiography, EKG/EEG, Respiratory Therapy, Sleep Studies, Special Procedures, Physical Therapy, Hand Rehab, Speech Therapy and Cardiopulmonary)
