Medical Imaging Provider Referral Forms and Instructions

MRI Outpatient Requisition
Medical Imaging Outpatient Services (2 pages) Requisition *New location
Cardiology, Respiratory, Neurology Requisition and Instructions (fillable form)
Angiography — Interventional Radiology Requisition
Critical Lab Results — Required for Non-Focal Liver Biopsy
CT Outpatient Requisition
CT Lung Cancer Screening Requisition and Patient Consent
Maternal Fetal Imaging Requisition
Consent to Release Personal Health Information— Consent Form

Follow these E-Form installation instructions:

Select the applicable requisition from the list below.
Right click “Save link as…” to save form on your desktop.
Open PS Suite.
Open a test patient’s chart.
Go to “Settings” (towards top-left of the screen).
Click “Edit Custom Forms” and a new page will pop-up.
Click “File”.
Click “Import Forms”.
To test the requisition form, open a test patient’s chart again and go to “Data”.
Select “New Custom Form” and this will open the requisition into the patient’s chart.
To add the physician’s signature, double-click on the signature box (this will only work if you are logged in under the physician’s account).

Requisitions:

Online access to imaging records through PocketHealth

North York General Hospital provides imaging records to patients and their care providers only through secure, online access. Learn more about the Access Page.

Guidelines for ordering CT exams with contrast

Abdominal and pelvic imaging typically requires contrast unless the study is being performed to assess adrenal nodules or kidney stones. Cancer imaging, and imaging obtained to work up infection is best performed with contrast. Additionally, all CT angiograms require IV contrast. Other common studies such as routine CT heads, spine imaging and low-dose CT chest are done with unenhanced technique.

COVID-19

Medical Imaging Provider Referral Forms and Instructions

Online access to imaging records through PocketHealth

Guidelines for ordering CT exams with contrast