You will be required to bring your medical aid card, request form from referring physician & authorisation number from your medical aid.
Below is an example of the form that you will be given when you make an appointment for your scan:
Contact Medical aid and get pre authorisation number.
Dr TJ Nel practice number – 3802841
Referring Dr’s practice number - ___________________
Procedure code
CT Abdomen & Pelvis pre & post – 40337
CT Triphasic Liver, Abdomen and Pelvis - 40340
CT Chest, Abdomen and Pelvis pre & post – 40355
CT Neck, Chest, Abdomen & Pelvis pre & post - 40360
Diagnosis code (ICD 10) - __________________
Please write down the name of the person who gave the authorisation.
Please download the form
IT IS VERY IMPORTANT TO FOLLOW THESE INSTRUCTIONS FOR THE TEST TO BE PERFORMED SAFELY AND PROPERLY AND TO HAVE ACCURATE RESULTS.
PLEASE REMEMBER TO BRING ALL PREVIOUS SCANS DONE AT OTHER FACILITIES.
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