This article contains printable versions of the Clinical Assessment Questions for Cardiac Positron Emission Tomography (PET), separated by diagnosis. Ensure you select procedures that best align with the primary diagnosis.
The questions in these documents are for reference only. PLEASE DO NOT FAX ANY OF THESE FORMS. These questions are designed to capture key information about the patient's specific clinical situation based on the diagnosis and services requested for approval. Answering these clinical assessment questions increases our ability to issue an auto-approval, which could save you time.
*Note that these questions are subject to change at any time without notice.*
See the table below for individual forms separated by diagnosis.
*Last updated: February 25, 2022*
|Primary Diagnosis||Link to Cardiac Positron Emission Tomography (PET) Questions|
|Chest Pain||Click here|
|Coronary Artery Disease (CAD)||Click here|
|Shortness of Breath||Click here|