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Imaging

All imaging related eForms goes here
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
PET Scan Requisition - UBC
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.
BCWH Mammography and Breast Health Referral Updated Dec 2011
Generic Bilingual imaging requisition
pure HTML. Created by Earl Wertheimer.
Generic Outpatient Imaging forms October 2014
Update --- Forms created for several communities in the lower mainland (BC), still has capacity to be modified for other areas. ---This form was originally created by JohnY and has some code that is specific to New Westminister in BC, but can easily be modified to fit any local. JohnR.
Prevention of Contrast Induced Nephropathy
This was originally developed for The Scarborough hospital, but is more generic. Last Updated August 13 2014
Updated FHA MRI requisition
This requisition has updated background, with updated checkboxes and "check it" function for default payer. It requires a new image file. DO NOT delete your old MRI image file. You can rename your old MRI e-form, and replace with this one.
Fraser Health Imaging form
Updated October 2014 link to folder in Fraser Health Forms
Chilliwack specific interactive guideline based imaging requisition
Link to the Chilliwack version of the form

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