Hospitals & Services
Electronic order entry (e-referral)
Nuclear Medicine Requisition form QF00287. CDHB staff can view this form on the Intranet under Forms - Service /Department - Nuclear Medicine. http://cdhbintranet/corporate/cdhbpoliciesanddocumentation/CDHB%20Forms/Nuclear%20Medicine%20Request%20Form.pdf
Deliver or fax the form (ext. 80869) to the Nuclear Medicine Department.
Nuclear Medicine Requisition form QF00287.
Post or fax (03 3640 869) the form to the Nuclear Medicine Department.
Nuclear Medicine Request Form - available on the CDHB HealthPathways website http://cdhb.healthpathways.org.nz/referral/Nuclear-Medicine-Request-Form.pdf. Post or fax the request to the Nuclear Medicine Department or send via GP Referrals.
ERMS referral. Healthpathways - Investigations - Nuclear Medicine - Request. Select: Bone Isotope Scan, Radionuclide Thyroid Scan or Nuclear Medicine Referral for other scan types.
For clinical criteria, refer to Bone Pain Pathway or Thyroid Pathway.
ACC funded Bone Scans must be referred by a Specialist.
Full name of patient ie. legal name including all middle names with correct spelling
Date of birth and NHI number
Mailing address including postcode
Contact telephone numbers (include cell for txt reminder).
Name of Referrer and Practice
ACC number if applicable, include date and details of accident
Provisional diagnosis and /or presenting problem
Severity and duration
Current medications/ known allergies
Relevant patient history
Any disabilities, mobility or cognitive problems, special needs eg. interpreter, hoist etc.
For URGENT scans during working hours (0800 - 1630), phone the Scanning room (03 3640 867, ext. 80867) after faxing or sending an electronic referral. Urgent requests are performed as soon as possible.
All efforts are made to scan patients within the requested time frames indicated on the referrals.
Routine appointments are generally booked and sent out within a week.
Some types of scans are grouped together and others are only available on certain days.
Some specialised scans are not routinely available, contact Nuclear Medicine for advice before ordering.