Pediatric CT Scan

Ordering Instructions

If Contrast is ordered:

  • BUN and creatinine are required within 30 days before the exam if the patient is diabetic, or has a history of renal insufficiency.
  • Metformin medications need to stop on the appointment day and for 48 hours after the exam. Please consult with your patient.
  • Allergy prep is required if the patient has a known iodine contrast allergy or history of allergic reaction during injection of intravenous contrast. Please call CT clinical triage if unsure: 909-558-4000 x50944.

Ordering Forms

The exam request form is interactive. You should type information in the free text fields and select the requested exams from the drop down menus.  

For example:

Complete the form, print, sign and fax according to the information at the bottom of the page.