Northwestern Medical Center (NMC) requires a physician’s order prior to scheduling of diagnostic imaging services. NMC also requires insurance and prior authorization information prior to scheduling. Orders should be faxed to Diagnostic Imaging on 802-524-1289. If the order is for a requested STAT study, please follow up with a phone call to 802-524-1058 to alert the STAT request and obtain an appointment date and time. Please review our guide for determining appropriateness of STAT or Urgent orders
Should NMC receive a faxed order missing the minimum required elements listed below, NMC will not schedule the exam, and will need to call or fax the ordering provider for the required information. providing these elements with the initial order will minimize delays in patient care.
NMC remains committed to returning to the availability of walk-in testing for certain modalities/exams when there is a completed provider order in place.
For providers without an Electronic Medical Record capable of generating an order with the required elements, you may use the forms provided below. Note, Breast Imaging and or Lung Screening exams require the use of the NMC form or a facsimile that includes all the requested data elements.
Minimum Required | Definition |
First Name | The patient’s given name. |
Middle Name | The patient’s middle name or further given names. |
Last Name | The patient’s surname. |
Date of Birth | The patient’s date of birth |
Test or Service Requested | Modality and specific exam. Including laterality and contrast if applicable. |
Reason for ordering the Test or Service | (Please indicate more than a rule out, preferably an ICD-10 Diagnosis Code) |
Provider Name | Full and legible name of the ordering provider. |
Provider Signature | The order must be signed or otherwise legitimately authenticated by the ordering practitioner. This means a handwritten signature, or one electronically applied through an authenticated electronic medical record. Signature stamps are not acceptable per CMS. |
Acceptable Orders for Imaging Procedures
CMS recently published a transmittal which provides specific requirements associated with authenticating orders for tests. To encourage and implement best practice for our orders, we will be utilizing these guidelines for all payors. Questions you may have:
QUESTION: Are stamped signatures acceptable in test orders?
ANSWER: No. they are not. CMS has confirmed that services provided and ordered must be authenticated by the author. The method used shall be a handwritten or an electronic signature. Stamped signatures are not acceptable.
QUESTION: May staff sign orders for or as the ordering provider verifying that they have taken a verbal order from that provider?
ANSWER: No. They may not. Your staff may create the order, but services ordered must be authenticated by a handwritten or electronic signature of the provider.
QUESTION: Will my patients be turned away if they do not have a validly signed order?
ANSWER: Your patients will not be turned away, but their service will be delayed until a validly signed order is received. We will contact you as quickly as possible to get a validly signed order to minimize any delays for your patients.
QUESTION: How will you handle studies scheduled to occur after normal business hours when our office is closed and unavailable for confirmation of the order and my patient presents without a validly signed order?
ANSWER: If the order is otherwise straight-forward, but missing a valid signature, we will perform your patients study when outside of normal operating hours. however, we will contact you as quickly as possible the next business day to get a validly signed order.
QUESTION: How do these clarified requirements apply to me as I care for my own patients?
ANSWER: These updates clarify long-standing signature requirements and how they will be interpreted by government program auditors. The requirements apply to all services provided to government program beneficiaries and are not unique to diagnostic tests, so they are applicable to your practice if you see Medicare patients. You may want to review these guidelines as they apply to your own practice.
Please see the following references for more information on signature requirements:
Electronic signatures
Electronic signatures should contain date and timestamps and include printed statements, e.g., “electronically signed by,” or “verified/reviewed by” followed by the practitioner’s name and preferably a professional designation.
Note: The responsibility and authorship related to the signature should be clearly defined in the record.
- ‘Electronically signed by’ with provider’s typed name
- ‘Electronically verified by’ with provider’s typed name
- ‘Reviewed by’ with provider’s typed name
- ‘Authenticated by’ with provider’s typed name
When it comes to proper signatures, here’s a few
quick things to remember:
- Always sign your orders —submitted records with just a typed signature/signature line with no handwritten or electronic signature are not acceptable.
- You may print your name along with your written signature for clarification
- Initials must also have a printed name for clarification—when a note is from an inpatient setting, a full signature is preferred along with a printed name.
- Notes that have been transcribed should always be reviewed and signed—either electronically or with a hand-written signature— by the author of the note.
- Signatures should be legible
Acceptable forms of signatures
Legible handwritten signatures or initials
Note: Handwritten signatures should be legible, and the reviewer must be able to
determine whose signature is used. Stamped signatures are not acceptable.
- legible full signature
- legible first initial and last name
- Initials over a typed or printed name
- Illegible signature over a typed or printed name
- Illegible signature where the letterhead, Addressograph or other information on the page indicates the identity oi the signatory Example.- An illegible signature appears on a prescription. The letterhead of the prescription lists 3 physicians’ names. One of the names is circled
- illegible signature NOT over a typed/printed name and NOT on letterhead
but accompanied by: 1) a signature log or 2) an attestation statement - Initials not over a typed/printed name and NOT on letterhead but accompanied by: a signature log. or 2) an attestation statement
- Unsigned handwritten note where other dated entries on the same page in the same handwriting are signed