Upload Document Anderson
Please use this form to send us supporting documentation
Please use this form to send us supporting documentation
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Location
Anderson
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Modality / Type of Exam
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MRI
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Bone Density
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Doctor Order / Healthcare Provider Referral Form
Insurance Card
Implant and or Medical Device Card
Other
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Doctors Order / Healthcare Provider Referral Form
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Insurance Card
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Implant and or Medical Device Card
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Additional Information
Additional Comments you would like to share?
Anderson Radiology takes the security and privacy of protected health information very seriously. We have implemented technical, administrative, and physical safeguards, which are designed to protect your information from unauthorized use and access. These safeguards are intended to ensure that our system is secure and that it meets our obligations under the HIPAA Security Standards Final Rule, as well as CCHIT Meaningful Use Security Requirements to specifically protect all electronic health information created or maintained by our certified Electronic Health Record technology. By providing your information and consent, you are authorizing Anderson Radiology to acquire certain data required to calculate your estimated financial responsibilities related to the respective imaging exam you have selected on this request form. *
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Anderson Radiology takes the security and privacy of protected health information very seriously. We have implemented technical, administrative, and physical safeguards, which are designed to protect your information from unauthorized use and access. These safeguards are intended to ensure that our system is secure and that it meets our obligations under the HIPAA Security Standards Final Rule, as well as CCHIT Meaningful Use Security Requirements to specifically protect all electronic health information created or maintained by our certified Electronic Health Record technology. By providing your information and consent, you are authorizing Anderson Radiology to acquire certain data required to calculate your estimated financial responsibilities related to the respective imaging exam you have selected on this request form. *
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In the number 94847, what is the 5th digit?
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