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 KiB158
PET Order Form136.1 KiB55
Special Breast Procedures Order Form174.7 KiB65
CT Lung Cancer Screening Order610.1 KiB56
Prep Instructions
Barium Enema Prep Instructions61.7 KiB60
Barium Enema With Air Prep Instructions65.6 KiB48
Barium Enema Without Air Prep Instructions74.4 KiB65
CT Abdomen Pelvis Prep Instructions497.4 KiB86
Cyst Aspiration Prep Instructions93.8 KiB31
Ductogram Prep Instructions46.6 KiB41
MRI Preparation Screening Form210.1 KiB63
PET CT Bone Scan Prep Instructions157.7 KiB46
PET CT Brain Prep Instructions37.6 KiB42
PET CT Whole Body Prep Instructions71.8 KiB31
Small Bowel Series Prep Instructions92.1 KiB48
Stereo Imaging Guided Breast Biopsy Prep Instructions79.7 KiB44
Ultrasound Guided Thyroid Biopsy Prep Instructions35.6 KiB50
Ultrasound Guided Breast Biopsy Prep Instructions Copy79.7 KiB41
Upper GI Exam Prep Instructions78.2 KiB41
PET CT Prep Instructions V4163.9 KiB39
Ordering Guides
Breast Imaging Tip Sheet For Clinicians1.1 MiB66
Clinic Reference Card For Clinicians2.2 MiB50
CT Contrast Guide For Clinicians168.3 KiB81
Guide For Ordering CT Exams212.6 KiB32
Guide For Ordering MRI Exams175.6 KiB74
Guide For Ordering Ultrasound280.5 KiB65
Lung Cancer Guide For Clinicians48.7 KiB34

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