Imaging

Bone Density Requisition

Bone Density Requisition - Based on the BC standard outpatient bone density requisition

Breast Imaging - BC Standard

This is the BC standard breast imaging requisition. You can draw a circle over the breast image to indicate the suspicious lump. This updated version lets you preview the size of the circle instantaneously as you drag out the radius. - the drawing function only works in Firefox, it does not work in Internet Explorer

Breast Imaging - FHA

Based on the Fraser Health Breast Imaging Requisition. This updated version has allows you draw the a circle over the breast image and let you see the change in size "instantaneously". Just click at a point where you want to draw the circle and drag outwards. - the drawing function only works in Firefox, it does not work in Internet Explorer

CT scan - IV contrast related forms

Some forms used to satisfy the radiology department's concerns about the use of IV contrast in patients with renal dysfunction.

Diagnostic Imaging Requisition - Hamilton, Ont

 

Imaging Requisition

Based on the Fraser Health Radiology Department Req. You'll need to upload both the html file and the image file.

MRI - FHA

MRI Req based on the Fraser Health Authority Req

Nuclear Medicine - FHA

 

PET Scan Requisition - UBC

 

Valley Imaging Requisition

Imaging requisition for the private x-ray clinic in the Fraser Valley. Has a shortcut menu on the side to quickly fill in the body part to be x-rayed and related clinical indication.

VCH Imaging Requisition

This new requisition is used to access almost all hospital-based imaging services in the Vancouver Coastal Health authority. I've again incorporated drop down boxes for locations and phone numbers. Please inform me if there are inaccuracies, and I will correct. If any one can get an "original" pdf file of the form, I will use that as the background.

Bowel Preparation Instructions

New preparations are now recommended for patients with renal impairment. You will need to upload the html files to the e-form library, and the png files to the image library. If you have already used 2-page e-forms, you should have the print1.css and print2.css in the image library already. Otherwise, you will need to upload these as well.

VCH Medical Imaging Requisition - updated

Updated with pdf backgrounds. The 2nd page (locations) is more legible. The older requisition also works. You will need to upload the new png files for this html. If you have used the older version, do not delete the previous png file from your library.

Breast Imaging - BC Women's Hospital

BCWH will only accept their specific referral form. This was developed by Dr. J. Robertson.