Radiology orders
Radiology orders For scheduling outpatient procedures, please call: Cook Children’s Medical Center and Dodson Specialty Clinics 682-885-4076 - choose option 1, then fax this order to 682-885-3940. Cook Children’s Northeast Hospital 817-605-2909, then fax this order to 817-605-2910. Date of service__________________________ Time____________________ Ordering physician_______________________________________ Patient name_____________________________________________________ Date of birth_____________________________________________ Home phone_____________________________________________________ Work phone_____________________________________________ Location Cook Children’s Medical Center – 801 Seventh Ave., Fort Worth, TX 76104 – First floor, Radiology department, Registration 1 682-885-4076 phone C ook Children’s Dodson Specialty Clinics – 1500 Cooper St., Fort Worth, TX 76104 – Lower level, Radiology, Registration 3 682-885-2428 phone Cook Children’s Southwest Radiology – 6210 John Ryan Pkwy., Suite 105, Fort Worth,TX 76132 817-370-0575 phone | 817-370-8107 fax Hours: 9 a.m. – 5 p.m., Monday – Friday, for non-scheduled routine exams (chest, sinus images, extremities, etc.) Cook Children’s Northeast Hospital - 6361 Precinct Line, Hurst, TX 76054 817-605-2500 phone | 817-605-2910 fax Exam(s) ordered_________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Symptoms / reason for exam / diagnosis__________________________________________________________________________________ ________________________________________________________________________________________________________________________ If you have any questions, please call 682-885-4076 Instructions: Call report to phone #___________________________________ Fax report to fax #______________________________________ Stat report Release patient Hold patient Patient to return to office Release patient with orders to call office Release images to patient Physician signature Recent exposure to: Communicable disease Tuberculosis Immunizations up-to-date If required, notification to: ICN Yes No MD Rad RN Date —Present this form to the receptionist in the Radiology department— REV 2/12 · Cook Children’s Hurst Northeast Hospital 820 0 82 Fort Worth Cook Children’s Radiology locations 121/183 I-30 I-30 Arlington Cook Children’s Medical Center 820 I-35W 7 28 Cook Children’s Medical Center: 801 Seventh Ave. Cook Children’s Dodson Specialty Clinics: 1500 Cooper St. Cook Children’s Southwest Radiology ook Childrenís Family & Visitor Parking and Drop-off Locations rections to the 7th Ave Garage Parking for Family and Visitors Exit on I-30 and travel west. N Take the Summit Ave/8th Ave exit. Turn south on 8th Ave. Turn left on Pennsylvania Ave. Turn right on 7th Ave. Downtown Fort Worth I-30 Summit Ave/ 8th Ave Exit aveling north or south on I-35W: Behavioral Health Pennsylvania Ave Thistle Hill e 7th Ave Garage is on the left. 7th Ave Garage 8th Ave Take the Summit Ave/8th Ave exit. Turn south on 8th Ave. Turn left on Pennsylvania Ave. Turn right on 7th Ave. Dodson Specialty Clinics 3 Cook Childrenís Medical Center 2 e 7th Ave Garage is on the left. Cooper St 1 7th Ave rop-off locations with alet parking service Traveling north or south on I-35W Take I-35W until you reach I-30. Travel west on I-30. Take the Summit exit. Turn left on Summit. When you reach the third stoplight, turn left onto Cooper Street, which will lead to Cook Children’s Medical Center. Emergency Entrance W. Terrell Ave Medical Center Main Entrance Southland Parking Medical center families with a patient, may receive free parking in the 7th Avenue Garage, or you may valet for $5 at the main entrance. 6th Ave Pulaski 5th Ave W. Humbolt St Ronald McDonald House Henderson Emergency Parking Dodson Specialty Clinics Entrance S. Lake St Dodson Lower Level Entrance for Dodson Day Surgery and Dodson Radiology Pulaski Rosedale Building Entrance Visitor Parking Valet Parking C o o k C h i l d r e n ’s M e d i c a l C e n t e r • 8 0 1 S e v e n t h A v e . , F o r t Wo r t h , T X 7 6 1 0 4 • 6 8 2 - 8 8 5 - 6 2 0 0 • w w w. c o o k c h i l d r e n s . o r g OP Parking Directions Map 01/12 Cook Children’s Medical Center Campus Emergency Entrance 6th Ave. 6th Avenue Pruitt St. Medical Center Emergency Department Atrium First Floor B Emergency Parking N D A Valet Parking A Main Entrance Pedestrian Entrance Once your child is scheduled for an appointment at Cook Children’s Medical Center, you may pre-register online at www.cookchildrens.org. To pre-register by phone, please contact us at 682-885-2965, between the hours of 8:30 a.m. – 6 p.m., Monday – Friday. Please pre-register at least 24 hours prior to the check-in time. Family and Visitor Parking Vehicle Entrance 7th Ave. Registration 3 (Lower Level) Legend Information Desk Lower Level Entrance Department Entrance Registration 2 Valet Parking Cooper St. Restaurant Valet Parking Building Entrance Pedestrian Crossing Clinic Entrance 8 0 1 S e v e n th Av e . , F o r t Wo r th , T X 7 6 1 0 4 (682) 885-6200 www.c ook c h i l dren s .org A A Elevators B B Elevators C C Elevators D D Elevators Clinic Elevators W. Terrell Ave. Dodson Specialty Clinics Pruitt St. Parking for additional family or visitors is available in the 7th Avenue Garage located at Pennsylvania and 7th Avenue for $1 per hour with a $5 maximum charge. Valet is also available for $5. Registration 3 hours: 5:30 a.m. – 5:30 p.m., Monday – Friday. Camelot Court 7th Ave Garage (First Floor) Dodson Radiology families with a patient, may receive free parking in the 7th Avenue Garage or free valet in the lower level entrance. Valet parking is $5 for visitors. Registration information Registration 1 hours: 5 a.m. – 7 p.m., Monday – Friday and 7 a.m. – 7 p.m., weekends. B C Registration 1 Traveling east on I-30 Take the Summit exit. Turn right on Summit. When you reach the second stoplight, turn left onto Cooper Street, which will lead to Cook Children’s Medical Center. Traveling west on I-30 (or from I-35W) Take the Summit exit. Turn left on Summit. When you reach the third stoplight, turn left onto Cooper Street, which will lead to Cook Children’s Medical Center. Pruitt St W. Cannon aveling east or west on I-30: I-35W For registration after hours, please report to the Emergency Department.
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