Outpatient Order Forms
We have provided the following outpatient order forms for easy access for physician clinic staff to request a test to be performed at Faith Regional Health Services.
Please view our Instruction Guide for specific instructions on how to fill out the appropriate order form.
Outpatient Order Forms
Click on a link below and print and complete the order form to schedule the following tests:
- Blood Transfusion Order (Outpatient)
- Cardiovascular Pre-Cath
- Outpatient Orders (Cardiopulmonary, Vascular, Radiology and other ancillary tests)
- Lab Tests
- MSP Questionnaire
- PET/CT Scan
- Physician Direct Referral for Home Sleep Apnea Testing
- Physician Direct Referral for In-Lab Sleep Testing
- Rehab Tests: (Physical, Speech and Occupational Therapy)
Outpatient Patient Education Forms
Click on a link below to print the following forms:
CVI
Cardiopulmonary
- Bronchoprovocation Methacholine Challenge Test
- Discharge Instructions After Your Pulmonary Function Test PFT
- Discharge Instructions After Your Stress Test
- Lexiscan Cardiolite Stress Test
- Pulmonary Function Test PFT
- Sleep Deprived Electroencephalogram - EEG
- Transeophageal Echocardiography - TEE
Echo Vascular
- Adenosine Cardiolite Stress Test
- Ankle-Brachial Index ABI
- Discharge Instructions After Your Echo Vascular Ultrasound
- Dobutamine Stress Echocardiography - Echo
- Echocardiogram
- Exercise Stress Test
- Nuclear Medicine (Cardiolite) Treadmill Stress Test
- Radiofrequency Ablation Treatment for Varicose Veins - RFA
- Stress Echcardiography - Echo
- Understanding your Echocardiogram
- What Is a Duplex Ultrasound
Radiology
- Barium Enema for Outpatients
- Barium Exams Using Fluroscopy in Radiology
- Cardiac Blood Pool Image MUGA NMMUGA
- Diagnostic X-Ray Exams
- Fluroscopy Injections
- Intravenous Pyelogram - IVP
- Lumbar Puncture Discharge Instructions
- Lumbar Puncture
- Magnetic Resonance Imaging - MRI - Without or With Contrast
- Sedation Electroencephalogram
- Voiding cystourethrogram - VCUG