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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.

VCH Imaging Requisition - html: Upload this to your e-form section, and add both png's below to your image library.
VCH Imaging Requisition - page 1: This is the background for the requisition, front page.
VCH Imaging Requisition - page 2: This is the backside of the requisition, the location list.