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:
Lists general exam preparation instructions for Ultrasound, Gastrointestinal Imaging, Mammography and Nuclear Medicine.
Cardiac:
Lists preparation instructions for Myocardial Profusion Imaging (MPI), Cardiac Amyloidosis Scans and Exercise Stress Tests.
MRI & CT:
Lists preparation instruction information for MRI & CT procedures.
Pain Management:
Lists preparation instruction information for Pain Management procedures.
PET CT:
Lists preparation instruction information for PET CT procedures.
Women's Health Imaging:
Lists preparation instruction information for Women’s Health Imaging procedures.
Virtual Colonoscopy:
Virtual Colonoscopy prep instructions