Radiology

1. Locate the needed order set below, print, and complete the forms. All orders must contain patient name, date of birth, insurance information, ICD10 code, physician signature with printed name underneath.
2. Follow your office procedure for obtaining any authorizations needed. Include the authorization number. Please provide a contact name and phone number from your office.
3. Fax (337.494.2667) or email (Radiologyorders@lcmh.com) the physician order with all information requested.
4. Once the order and all requested information is received and reviewed by the appropriate modality, the patient will be contacted with an appointment date and time.
5. The physician office will be notified of confirmed appointment date and time.

Call Radiology 337.494.3070 if you have any questions

Breast Health Orders

Biopsy Request Form

Myelogram Request Form

Other Radiology Order Form

Breast Health Physician Exam Request Form

MRI