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Printable Order Forms

These standard PDFs can be printed, filled out by hand and signed by providers. Schedulers can then fax the order to Wake Radiology at 919-235-3940 (Main) or 919-933-9925 (Chapel Hill).

If you need more order form pads, educational materials or other supplies, please contact your physician liaison. If you don’t know who your physician liaison is, contact April White, Director of Physician Liaison Services. April can be reached at 919-788-7908 (office), 919-632-3318 (cell) or via email.

 Main Order Form
WR Main Order Form Jan 2014 thumb
WR Peds Order v5 Apr14 thumb
temp chiropractic order form thumbnail
 Breast MRI
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WR PETCT Order Form Jan 2014 thumb
Interventional Radiology
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& Sports Imaging
WR Ortho+Sports Imaging Form v1 Mar 2014 thumb

Downloading and using PDFs

Both the updated portal and the Form Center use PDFs to share information that wasn’t previously available.  PDFs are cross-platform files can be viewed and printed on any computer. Many systems have this capability built into their operating systems. Others rely on Adobe Reader for this function.

If you experience problems with PDFs, please try these tips.

  • Windows: Right click on the icon or button and save the file to your desktop
  • Mac: Control click on the icon or button and save the file to your desktop
  • Then, double-click the file to print or move it to a different place within your system

Need Adobe Reader? Click here. For more instructions on using PDF files, visit Adobe’s website.

CMS Signature Guidelines

All orders submitted to Wake Radiology must meet CMS signature guidelines. Learn more by downloading this guidelines.