[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-307768-105":53,"doc-detail-307768-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","radiology-order-form-woodward-medical-center","Radiology Order Form - Woodward Medical Center","","This document serves as an official radiology order form for the Woodward Medical Center, located in Bloomfield Hills, Michigan. It is designed for referring physicians to request various X-ray examinations, including thoracic, spinal, and extremity imaging. The form captures critical patient information such as date of birth, diagnosis, and physician contact details. Additionally, it provides specific patient instructions, contact information for the facility, and scheduling details for both standard and walk-in appointments.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/radiology-order-form-woodward-medical-center/307768/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/radiology-order-form-woodward-medical-center/307768.png","ImageObject",442,249,{"name":88,"@type":89},"Bulrr","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must a referring physician provide on this form?","Question",{"text":108,"@type":109},"The physician must include the patient's name, date of birth, diagnosis, and their own signature for the order to be valid.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What are the patient instructions regarding the order form?",{"text":113,"@type":109},"Patients are required to bring the physical order form with them to the imaging appointment.",{"name":115,"@type":106,"acceptedAnswer":116},"How can a patient reduce their wait time for a walk-in X-ray?",{"text":117,"@type":109},"Patients should call the office at 248-333-1172 prior to arriving for their walk-in appointment.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},307768,1790222873,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},5909892115043,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| | \u003Cbr>Radiology Order Form\u003Cbr>WOODWARD MEDICAL CENTER\u003Cbr>42557 Woodward Ave., Suite 100 • Bloomfield Hills, MI 48304-5038 |  |  | |\n| --- | --- | --- | --- | --- |\n| Phone 248-333-1172 • Fax 248-333-1173\u003Cbr>Today’s Date \u003Cbr>Patient’s Name  DOB  Referring Physician   CC  Diagnosis   Exam Date  Time  Fax \\#   Phone\\# \u003Cbr>PHYSICIAN’S SIGNATURE REQUIRED   |  |  |  |  |\n| IMPORTANT PATIENT INSTRUCTIONS\u003Cbr>• YOU MUST BRING THIS ORDER FORM WITH YOU AT THE TIME OF YOUR IMAGING.\u003Cbr>• TO DECREASE WAIT TIME, PLEASE CALL THE OFFICE PRIOR TO YOUR ARRIVAL. |  |  |  |  |\n| X-RAY:\u003Cbr>71045 □ Chest X-RAY Single View 71046 □ Chest X-RAY 2 View\u003Cbr>71101 □ Ribs Unilateral Inc. PA Chest 3 View\u003Cbr>72170 □ Pelvis 1 or 2 View 73000 □ Clavicle 1 View 73030 □ Shoulder 2 View 73060 □ Humerus 2 View 73080 □ Elbow 3 View 73090 □ Forearm 2 View 73110 □ Wrist 3 View 73130 □ Hand 3 View 73140 □ Finger 2 View |  |  | 73502 □ Hip Unilateral 2 View 73521 □ Hips Bilateral 2 View Each 73552 □ Femur 2 View\u003Cbr>73560 □ Knee 2 View 73590 □ Tibia/Fibula 2 View 73610 □ Ankle 3 View 73630 □ Foot 3 View 73660 □ Toe(s) 2 View\u003Cbr>74018 □ Abdomen Flat Plate/KUB 1 View 72040 □ Cervical Spine 2 to 3 View 72070 □ Thoracic Spine 2 View\u003Cbr>72100 □ Lumbosacral Spine 2 or 3 View\u003Cbr>* CPT codes in RED |  |\n\nSCHEDULING INSTRUCTIONS: Phone Number: 248-333-1172  \nSCHEDULE FOR EXAMS:  \n• Monday-Friday 9:00 am to 4:00 pm  \n• Walk-in Appointments: Contact office prior to arrival to reduce wait time.","cbCaitZhBDGizq6c","https://ap.wps.com/l/cbCaitZhBDGizq6c","pdf",274642,"English","# Patient and Physician Information\n## Important Patient Instructions\n# X-Ray Examination Options\n## Thoracic and Spine Imaging\n## Extremity and Pelvic Imaging\n# Scheduling and Contact Details","[{\"question\":\"What information must a referring physician provide on this form?\",\"answer\":\"The physician must include the patient's name, date of birth, diagnosis, and their own signature for the order to be valid.\"},{\"question\":\"What are the patient instructions regarding the order form?\",\"answer\":\"Patients are required to bring the physical order form with them to the imaging appointment.\"},{\"question\":\"How can a patient reduce their wait time for a walk-in X-ray?\",\"answer\":\"Patients should call the office at 248-333-1172 prior to arriving for their walk-in appointment.\"}]","Radiology Order Form - Woodward Medical Center | PDF",1789854685]