Radiology Exam Order Forms & Patient Information
Radiology Medical Necessity
- Cardiac Radionuclide Imaging
- Cardiac Scoring and CTA Heart (Cardiac Computed Tomography & Angiography)
- CT Abdomen & Pelvis (Computerized Axial Tomography of Abdomen & Pelvis)
- CT Chest (Computerized Axial Tomography of Chest)
- CT Head (CT of Head)
- DEXA Scan
- MR Angiography (MRA, Magnetic Resonance Angiography)
- MRI Orbit, Face, and Neck (Magnetic Resonance Imaging Orbit, Face, Neck)
- PET CT
- Retroperitoneal Ultrasound (Renal and Aorta)
Exam Orders
Physician referral order forms.
- CT Chest Low Dose Exam Form
- CT Request Form
- Diagnostic X-Ray Request Form
- MRI Request Form
- MRI Outpatient Screening Form
- Nuclear Medicine Request Form
- PET/CT Physician Order Form
- Special Procedures Request Form
- Ultrasound Request Form
- Women’s Imaging Request Form
Patient Exam Information
Information for patients about Radiology tests.
- CT
- Diagnostic Radiology: Special Procedures
- Diagnostic Radiology: Walk-in Exam
- MRI
- Nuclear Medicine
- PET/CT Patient Preparation Instructions
- Ultrasound Exam
- Women’s Imaging (Main Campus)
- Women’s Imaging (Staunton Outpatient Center)
Request & Authorization to Release Health Information
Patients need to complete this release to allow Augusta Health to request past imaging from other facilities where they have had imaging done.
What to Order
Recommended exams for common conditions.