The below files are to be used as a guide when referring patients for imaging services at the Outpatient Diagnostics Center or SampsonRMC.
The above pre-authorization chart is to be used as a guide. It is best to verify authorization for all patients as each patient's policy requirements may vary.
Patient's Insurance ID Number
Ordering Provider's Name & Tax ID #
CPT Code of Requested Exam
Prior Labs, Exams, Treatment, etc.
Facility Information: Sampson Regional Medical Center, 607 Beaman Street, Clinton, NC