For Clinicians

Clinicians who would prefer to use pre-printed documents and appointment cards, please contact the Marketing & Communication Program Director at (907) 212-6032.

Find a Form

Order Forms & Requisitions
Diagnostic Imaging Order Form497.7 KiB253
PET Order Form136.1 KiB101
Special Breast Procedures Order Form 2018254.7 KiB104
CT Lung Cancer Screening Order610.1 KiB100
Prep Instructions
Barium Enema Prep Instructions61.7 KiB111
Barium Enema With Air Prep Instructions65.6 KiB76
Barium Enema Without Air Prep Instructions74.4 KiB114
CT Abdomen Pelvis Prep Instructions497.4 KiB132
Cyst Aspiration Prep Instructions93.8 KiB42
Ductogram Prep Instructions46.6 KiB60
MRI Preparation Screening Form210.1 KiB105
PET CT Bone Scan Prep Instructions157.7 KiB74
PET CT Brain Prep Instructions37.6 KiB70
PET CT Whole Body Prep Instructions71.8 KiB49
Small Bowel Series Prep Instructions92.1 KiB80
Stereo Imaging Guided Breast Biopsy Prep Instructions79.7 KiB76
Ultrasound Guided Thyroid Biopsy Prep Instructions35.6 KiB86
Ultrasound Guided Breast Biopsy Prep Instructions Copy79.7 KiB65
Upper GI Exam Prep Instructions78.2 KiB68
PET CT Prep Instructions V4163.9 KiB69
Ordering Guides
Breast Imaging Tip Sheet For Clinicians1.1 MiB101
Clinic Reference Card For Clinicians2.2 MiB66
CT Contrast Guide For Clinicians168.3 KiB124
Guide For Ordering CT Exams212.6 KiB56
Guide For Ordering MRI Exams175.6 KiB107
Guide For Ordering Ultrasound280.5 KiB95
Lung Cancer Guide For Clinicians48.7 KiB52

See all Forms here.

  • Auto-faxing of imaging reports to ensure quick turn-around time. A green-bordered “hard” copy of the report will also delivered via courier or mail. Contact us at (907) 212-6039 to arrange for autofax.
  • Access to a Radiologist is available to clinicians via telephone at (907) 212-3148, Monday – Friday, 8 a.m. – 5 p.m.


For a complete list of forms and other materials that you can download, click here.

Providence Alaska Provider Directory and Other Resources