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Orange County Diagnostics Forms


Please print, fill out and deliver the appropriate forms to your scheduled appointment. If you have never been a patient at any of our locations, print all of the 'New Patient Registration' forms. If you have been a patient, print 'Existing Patient Registration' forms. Then, find your procedure and print the corresponding forms. If your procedure is not listed, you have no additional forms to print.


Doctor's Office Forms:


Referral
Authorization
Lien


Patient Forms - English

 

 

 

 

 

 

 

El Paciente Forma - Espanol

 

 

 

 

 

 

 


Instructions:

Please arrive 20 minutes prior to your apopintment time.
Paperwork can be printed from above.
Bring your insurance card, ID and order form with you.
To provide your physician with the most accurate and timely results, we request that you bring any previous radiology exams that are pertinent to your current condition.


MRI Examination
If your exam requires contrast, DO NOT eat solid food two hours prior to your exam. Please notify scheduling if any of the following pertains to you: cardiac pacemaker, aneurysm clips, cochear implants, if you are an occupational metal worker or claustrophobic.

CT Examination
If your exam requires contrast, DO NOT eat solid food two hours prior to your exam. Drink plenty of fluids prior to your appointment. Please notify scheduling if you are taking medication for diabetes or have a known allergy to iodine.

Ultrasound Examination
Abdominal - No food or drink 6 hours prior to your examination


Pelvis - Finish drinking 32oz of water one hour prior to your appointment. DO NOT VOID - a full bladder is required for this exam


OB 1st Trimester -Finish drinking 32oz of water one hour prior to your appointment. DO NOT VOID - a full bladder is required for this exam


OB 2nd & 3rd Trimester - Finish drinking 16oz of water one hour prior to your appointment. DO NOT VOID - a full bladder is required for this exam.

Mammography
Please do not wear powder, deodorant, lotion or perfume on the day of the exam. Bring your prior mammogram for comparison.

Breast Biopsy
Please DO NOT take any aspirin product one week prior to appointment. Inform scheduling if you are taking any type of anti-coagulate drugs. Bring your most recent mammogram with you, if not done at our facility.

Fluoroscopy
Most fluoroscopy procedures require a preparation before the examination. Scheduling will give you instructions specific to the exam requested.

Nuclear Medicine
Preps vary according to the exam. Specific instructions will be given by the scheduling department. You may be asked to avoid eating, drinking or certain medications for a period of time prior to your exam. Additionally, please be sure to inform the schedulers and staff if you are diabetic, pregnant, uncertain if you may be pregnant or currently breat feeding.

PET/CT

Inform the scheduler if you are diabetic, pregnant or nursing - additional instructions will be provided.

 

Three days prior to exam:

-Avoid smoking or strenuous exercise

 

One day prior to exam:

-Drink plenty of fluids to hydrate your body

-Consume a dinner high in protein and low in carbohydrates the night before exam

 

Day of exam:

-Do not eat or drink anything (except for water & medications) 6 hours prior to your exam. This is critical to the performance of the exam.

-You may take medications as prescribed during the day of your exam - with water only

-Dress warmly and comfortably

- Do not wear jewelry or clothing with metal zippers or metal buttons

- Leave all valuables at home

-Your exam will take approximately 2-3 hours