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.
Requisition Forms
Exam Prep Forms
General: This covers general exam preparation instructions, like Fluoroscopy, Ultrasound, Nuclear Medicine, Bone Densitometry, and Mammography.
Cardiac: Lists preparation instructions for Exercise MIBI, Exercise Stress Test, and Cardiac Ultrasound exams.
MRI & CT: Lists preparation instruction information for MRI & CT procedures.
Pain Management: Lists preparation instruction information for Pain Management procedures.
Women's Health: Lists specialized information for Ultrasound (general and Obstetrical), Mammography, and Bone Densitometry.
Virtual Colonoscopy: Virtual Colonoscopy prep instructions