​​​Hospital Referrals

 Private Specialist Referrals

  • Nuclear Medicine Requisition form QF00287. 

  • Post or fax (03 3640 869) the form to the Nuclear Medicine Department.

GP Referrals

  • Nuclear Medicine Request Form - available on the CDHB HealthPathways website 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 ScanRadionuclide 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. ​

Referral Guidelines


  • 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

  • Service Requested

  • 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.

  • ​​​

Availability of Imaging Procedures

  • 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.  

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Page last reviewed: 23 March 2015