Providence Imaging Center provides several forms that you can download and print, including:

Release Forms

Mammography Release	Use this form to request a medical facility to send PIC mammography films/report(s).
Patient Release	Use this form to have PIC release films/images/report(s) to patients.
Outside Films Release	Use this form to request a medical facility to send PIC other types of films/images/reports.

Preps/Instructions

CT Prep Sheet	Use this form to check off the appropriate patient prep instructions for drinking the oral CT contrast used in abdomen and abdomen/pelvis CT scans.
Barium Enema Prep Package Instructions	This two-day prep utilizes a prep kit that is available at your clinician's office or at the front desk of PIC. It ensures that your colon is clean and empty for a succesful examination.
Barium Enema with Air	This two page PDF explains what to expect when you're having a Barium Enema with air, the most common Barium Enema test.
Barium Enema	This two page PDF explains what to expect when you're having a Barium Enema without air.
Upper GI Exam	This two page PDF explains what to expect when you're having an Upper GI Exam.
Small Bowel Series	This two page PDF explains what to expect when you're having a small bowel series exam.
PET-CT Prep Sheet for Whole Body Imaging	This 12-hour prep ensures that we obtain the best pictures possible.
PET-CT Prep Sheet for Brain Imaging	This prep ensures that we obtain the best pictures possible for patients who have a PET-CT of the brain. Instructions are applicable twelve (12) hours before your appointment.
Breast Cyst Aspiration	This two page PDF that you can download and print includes helpful information on what to expect during the procedure.
Thyroid Biopsy Instructions	This one page PDF that you can download and print includes helpful information on what to expect during an ultrasound-guided thyroid biopsy.
Breast Biopsy Instructions	This two page PDF that you can download and print includes helpful information on what to expect during the procedure.

Brochures

Bone Densitometry (DXA) brochure	Learn about our Hologic Discovery DXA scanner and why bone density testing is important.
Mammography brochure	Learn about digital mammography and what to expect during a mammogram at PIC.
MRI brochure	A handy reference that explains what to expect during an MRI exam.
PET-CT patient brochure	Learn what makes integrated PET-CT superior to stand alone PET scanners, and what to expect.

Screening Forms

MRI Screening Form

All patients fill out this two sided form to help ensure a safe exam.

Order forms/requisitions

PIC Order Form	This is our current requisition form last revised 5/07, the familiar two sided one with the PIC people in the upper left hand corner.
PET-CT Order Form	A PET-CT requires that we get some special information in order to get the most accurate results possible. Patients also follow a special diet.
Special Breast Procedures Order Form	This form released July 2007 is ideal for requesting an MRI of the breast, and includes all breast imaging offered at PIC.

Directions with appointment card/map

Map of PIC	This full-page map is a PDF file that you can download and print, and shows where PIC reserved parking is located.
Directions/Appointment card	This two-sided card provides patients a map with travel/parking directions, and has a space to write appointment information.

General information/reference cards

Clinician Information Card	This one-sided reference card provides clinicians and staff with general information about PIC including our services, scheduling, hours of operation, and contact information.
How-to-Schedule information sheet for mammography	This handy two-sided reference card provides helpful information on correctly scheduling mammography and other breast imaging
PET-CT Medicare Reimbursement Guide	This handy two-sided reference card provides helpful information on which PET exams are covered by Medicare as of April 2005

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