Requests

Downloadable Documents

Referral Forms

• Adult Referral – English | Spanish
• Pediatric Referral – English | Spanish
• Neuroradiology Referral
• MSK Referral
• Interventional Referral
• PET/CT Prescheduling Form w Instructions
• PET/CT Prescheduling Form w Instructions SPANISH
• PET-CT Axumin Scheduling Form Feb 2017
• PET/CT Axumin Prescheduling Form SPANISH
• MRI Prostate Referral Form
• CT Lung Screening or LDCT Form
• CT Dental Scan Order Form

Program Sheets

• ARA Diagnostic Imaging Professional Services
• Contrast CT MRI Guidelines
• CT-MRI CPT Code Diagram

Flyers

• PACS eUnity Mobile Instructions
• ARA Locations and Maps
• Technical Assistance Center
• UFE Information – Spanish

Helpful Authorization Websites/Links

• BCBS of Texas 
• Aetna, Cigna, Traditional Medicaid, Amerigroup Medicaid, and Physicians Health Choice 
• Humana
• United Healthcare PPO, Evercare Medicare, Secure Horizons Medicare, and AARP Medicare Replacement Plan 
• Superior Medicaid
• Tricare South