Guide
What Should an Imaging Order Include?
Complete checklist of required information for valid MRI, CT, X-ray, and ultrasound orders. What imaging facilities need to accept your order.
Get Your Order NowThe Complete Medical Imaging Order Checklist
A valid medical imaging order must contain specific information for the imaging facility to safely perform your test and bill appropriately. Here's what a complete order should include:
Whether you receive a handwritten, printed, or electronic order, all of these elements should be present. If your order is missing any critical information, contact the provider to request a complete version before attempting to schedule imaging.
Essential Patient Information
Patient Full Name
Why needed: Prevents patient mix-ups. Used to match your identity at the facility.
Example: John Robert Smith
Date of Birth
Why needed: Confirms you are the correct patient. Critical safety check.
Example: 01/15/1975
Patient ID or Medical Record Number (MRN)
Why needed: Helps facility locate your records and billing information.
Example: Optional but recommended if available
Contact Information
Why needed: Allows facility to reach you for scheduling and results.
Example: Phone: 555-123-4567 | Email: patient@email.com
Insurance Information (if applicable)
Why needed: Enables facility to bill your insurance and determine coverage.
Example: Carrier name, member ID, group number
Clinical Information Required
Clinical Indication / Reason for Study
Why needed: Explains why imaging is medically necessary. Critical for medical justification and insurance approval.
Example: Persistent lower back pain with left leg radiating pain for 6 weeks unresponsive to conservative treatment
Type of Imaging
Why needed: Specifies which body region and modality (MRI, CT, X-ray, ultrasound).
Example: MRI Lumbar Spine or CT Chest with Contrast
Body Part or Region
Why needed: Tells technologists exactly which area to image.
Example: Lumbar spine (L1–S1) or Right knee or Brain
Imaging Protocol / Special Instructions
Why needed: Guides technologists on specific protocol (standard, with contrast, 3D reconstruction, etc.).
Example: MRI lumbar spine standard protocol or CT chest with IV contrast
Urgency / Priority
Why needed: Indicates if imaging is routine, urgent, or stat (immediate). Affects scheduling.
Example: Routine or Urgent or STAT
Safety and Medical History Information
Allergy Information (especially contrast allergy)
Why needed: Critical safety issue. Alerts facility to use appropriate contrast agents or avoid contrast if necessary.
Example: NKDA (No Known Drug Allergies) or Contrast allergy specified
Pregnancy Status
Why needed: MRI is generally safe in pregnancy, but facility needs to know. Some protocols are modified.
Example: Pregnant (16 weeks) or Not pregnant or Unknown
Kidney Function (eGFR) if Contrast Planned
Why needed: Essential for gadolinium contrast safety. Prevents nephrogenic systemic fibrosis in kidney disease.
Example: eGFR 75 mL/min/1.73m squared or Recent creatinine value
Metal Implants or Devices
Why needed: Critical for MRI safety. Some implants are contraindicated. Prevents injury from magnetic field.
Example: Pacemaker or Metallic joint replacement—compatible with MRI
Prior Imaging Results (if relevant)
Why needed: Helps radiologist compare current study to prior exams. Detects changes.
Example: Prior X-ray normal 3/2024 or Prior MRI available at Hospital XYZ
For technical guidance on gadolinium contrast safety and eGFR thresholds used by radiologists, the ACR Manual on Contrast Media is the definitive clinical reference.
Provider Information and Authorization
Provider Name and Credentials
Why needed: Identifies who authorized the imaging and verifies provider is licensed.
Example: Dr. Jane Smith, MD, Orthopedic Surgery or John Doe, DO
Provider License Number (optional)
Why needed: Allows facility to verify provider is legitimately licensed.
Example: State Medical License: MD-1234567
Provider Signature or Electronic Authorization
Why needed: Legally required. Proves the order was authorized by a licensed provider.
Example: Handwritten signature or electronic signature with timestamp
Provider Contact Information
Why needed: Allows facility to reach provider with questions about the order.
Example: Phone: 555-456-7890 | Fax: 555-456-7891
Date and Time Order was Issued
Why needed: Establishes order validity period. Orders typically valid 30–90 days.
Example: 5/23/2026, 2:30 PM
Common Omissions and How to Fix Them
If your imaging order is missing critical information:
⚠️ Missing Clinical Indication
Impact: Facility may refuse to schedule—cannot justify medical necessity.
Fix: Contact provider and ask them to add clinical reason
⚠️ Vague Body Part Description
Impact: Technologists unsure which region to image—wrong anatomy may be scanned.
Fix: Request specific body part and confirm laterality (right/left)
⚠️ Missing eGFR for Contrast Order
Impact: Facility cannot administer contrast safely. Exam may be cancelled or delayed.
Fix: Get blood test for kidney function (eGFR) and attach result to order
⚠️ No Provider Signature
Impact: Order is not legally valid. Facility will not process it.
Fix: Request signed or electronically authorized copy from provider
⚠️ Expired Order Date
Impact: Order validity has lapsed. Facility may refuse to schedule.
Fix: Request a new order from provider within valid timeframe (30–90 days)
Sample Imaging Order Format
Here's what a complete imaging order should look like:
MEDICAL IMAGING ORDER
Patient Name: John Robert Smith
DOB: 01/15/1975
Contact: 555-123-4567
Clinical Indication: Persistent lower back pain with left leg radiculopathy. 6 weeks, unresponsive to conservative treatment. Rule out disc herniation/stenosis.
Imaging Type: MRI Lumbar Spine
Body Region: Lumbar spine (L1–S1)
Protocol: Standard protocol, no contrast
Urgency: Routine
Allergies: NKDA
Pregnancy: No
Metal Implants: None
Provider: Dr. Jane Smith, MD, Orthopedic Surgery
License: MD-1234567 (State)
Signature: [Electronic Signature: JS 5/23/2026 2:30 PM]
Contact: 555-456-7890
Frequently Asked Questions
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Disclaimer
This information is educational. Imaging order requirements may vary by facility and state. Always confirm specific requirements with your chosen imaging facility before scheduling. An imaging order is issued only when a licensed provider determines imaging is medically appropriate.