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Home Healthcare Professionals Cath Lab Interventional Radiology Non Invasive Cardiology

Cath Lab Interventional Radiology and Non-Invasive Cardiology Request

Please use the form on this page to request cath lab/interventional radiology and non-invasive cardiology appointments at UCI Health — Lakewood. For questions, call Cath Lab Scheduling at 562-602-5124 or 562-602-6704.

 

Cath Lab Interventional Radiology Non Invasive Cardiology Request Form

Patient Information

Non-Invasive Cardiology

Keep scrolling for the Interventional Radiology procedures questionnaire

Echo Procedure

Special Equipment - PCI

Devices

EP/Ablation

Interventional/Neuro IR Department Online Scheduling

Primary Insurance Information - All Procedures

Secondary Insurance Information

*If no Secondary Insurance or Worker's Compensation applicable, click cursor into Scheduler Name field.

Worker's Compensation Information (if applicable)

Scheduling Information

Questions? Please call Cath Lab Scheduling 562-602-5124 or 562-602-6704

Orders (procedures, diagnosis & doctors' signatures); H&P within 30 days of procedure date, if not, please update; Authorization; Demographics/Insurance cards; EKG; Labs; Echocardiogram report; CXR report; Prescriptions; Medication list; Device form; Other outside reports, previous bypass surgery, stress test, etc.

Thank you

Thank you, your form has been submitted.
Questions? Please call Cath Lab Scheduling at 562-602-5124 or 562-602-6704.