Loading
Get X Ray Referral Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the X Ray Referral Form online
This guide provides clear, step-by-step instructions for completing the X Ray Referral Form online. Whether you are a healthcare professional or involved in a referral process, this comprehensive guide will help you navigate each section effectively.
Follow the steps to complete the X Ray Referral Form online.
- Press the ‘Get Form’ button to access the X Ray Referral Form and open it in your online editor.
- In the 'Patient' section, fill in the patient's NHS number, forename, surname, and full address, including house number, road, locality, post town, and postal code.
- Provide the date of birth and the preferred home telephone number for the patient.
- If applicable, enter the patient's work telephone number.
- In the 'Referrer' section, list your full name and your GMC/HPC/NMC number. Include your address and the referring Clinical Commissioning Group (CCG) code and practice code.
- Enter your contact telephone number for urgent clinical findings, along with your mobile number and email address. Indicate the patient's gender.
- If necessary, specify any physical or communication difficulties the patient may have. Confirm if the patient is eligible for NHS funded transport and if they are a wheelchair user.
- If an interpreter is needed, specify the language required. Ensure that the patient can transfer independently onto the examination couch.
- Complete the ethnicity field as required.
- In the 'Presenting complaint & provisional diagnosis' section, provide detailed clinical information to ensure appropriate investigation as per regulations. The date of referral should also be filled in.
- As the referrer, sign the form to comply with the Ionising Radiation (Medical Exposure) Regulations. Indicate which investigations are required by ticking the relevant boxes for the body parts and sides.
- For female patients of child-bearing capacity, respond to the questions regarding the possibility of pregnancy and note the date of the last menstrual period if applicable.
- Once you have filled out all necessary sections, save your changes. You can then download, print, or share the completed form as needed.
Complete your X Ray Referral Form online today to streamline the referral process.
Self-referring for an x-ray might be an option at some imaging centers that allow it. However, most patients benefit from using an X Ray Referral Form provided by a healthcare professional, ensuring that the x-ray is appropriate and covered by insurance. Always check your local facilities to explore your options.