Checklist for X-ray Request Forms

Post on 29-Sep-2015

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description

xray request form audit tool

Transcript of Checklist for X-ray Request Forms

Radiology Department Thamaga Primary HospitalCHECKLIST FORM FOR X-RAY REQUEST FORMSReporting Period: ..No. Request FormWardDateRequesting officers nameName of patientAge of patientSEXLNMPX-ray RequestedPrevious x-rayClinical historyRequesting officers signature