You can download an AIS order form for quick use or look up a CPT code here on our website. Or contact our nearest AIS Location if you would like printed versions of any of these available materials. Our field representative can then come by your offices, when convenient for you, and drop off your AIS support items.
Order Forms:
• MRI & CT Order Form – Bellevue & Lynnwood
• MRI Order Form – Boise
• Dedicated Breast MRI Order Form
Screening Forms:
• CT Patient Screening Form
• MRI Patient Screening Form
Patient Forms:
• CT Scan Patient Consent & Acknowledgement
• MRI Scan Patient Consent & Acknowledgement
• Patient Request to Access Protected Health Info (PHI)
• Patient Rights and Responsibilities