Every diagnostic image at MIC starts with a requisition form filled out by a practitioner. All MIC requisitions are available as auto-fill forms in your EMR. We will also supply your office with hard copies or you can print them using the downloadable pdf forms below.
By completing the requisitions below, you are confirming you are an authorized licensed practitioner.
Requisition Forms
Exam Preparation Forms
General:
Lists general exam preparation instructions for Ultrasound, Mammography and Nuclear Medicine examinations.
Cardiac:
Lists preparation instruction information for Cardiac examinations.
MRI & CT:
Lists preparation instruction information for MRI & CT examinations.
Pain Management:
Lists preparation instruction information for Pain Management examinations and procedures.
PET CT:
Lists preparation instruction information for PET CT examinations.
Women's Health Imaging:
Lists preparation instruction information for Women’s Health Imaging examinations.
Virtual Colonoscopy:
Virtual Colonoscopy preparation instructions.