Referring Physician's Responsibilities for NOPR

 It's as easy as 1, 2, 3 . . .

The patient's referring physician must agree to complete Pre- and Post-PET data collection forms that include three to five questions regarding the patient's planned management.

  • The referring physician must complete the Pre-PET Form and return it to UVA Radiology prior to the patient's PET scan. The Pre-PET Form will be e-mailed by NOPR to the referring physician. For convenience it is also available at any time for download. The Pre-PET Form must be returned to UVA Radiology by FAX (434-982-4019).

  • After the PET scan is performed, and a final report has been issued the Referring Physician must complete a post-PET form which contains 4-8 questions about patient management in light of the PET scan results. The form also asks for physician consent for the data to be used in NOPR research.  This form must be returned to UVA Radiology by FAX (434-982-4019).

The case is eligible for CMS reimbursement only if:

  • the Pre-PET Form is completed and returned to UVA Radiology prior to the PET scan

  • the Post-PET Form is completed and returned to UVA Radiology within 30 days of the PET scan.

 1.

Schedule your
patient for PET-CT
with UVA by calling:
434-243-6888

Use the Standard PET Request Form

 

2.

 Referring Physician is required
to fill out ONE pre-PET form
before the PET-CT scan

Fax the completed
form to:
434-982-4019

 

 PET-CT report will be sent from
UVA Radiology to Referring MD

3.

 Fill out the post-PET form
which will be e-mailed
to the Referring MD 

Fax the completed post-PET form to:
434-982-4019

  You may view the post-PET forms, but be aware that these are six different one page forms. You will only need to fill out the ONE form, e-mailed to you which applies directly to the Specific Reason for the PET-CT.

For more infomation call:
Tia at 434-982-3182

or e-mail us at:
uvapetregistration@virginia.edu