MRI SCREENING FORMPhysicians, please download and fill out this form to accompany your patient’s referral for an MRI exam. Your patient may bring this form with them on the day of their exam.
MRI CPT Code Sheet
CT CPT Code Sheet
SHARED DECISION MAKING VISIT FORM
Ultrasound CPT Code Sheet
IV Sedation Guide
X-Ray Code Sheet
© 2023 Intermountain Medical Imaging. All Rights Reserved.