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Tions MUST be completed IMPORTANT - REFERRING DOCTOR S SURGERY TO COMPLETE Patient Code / U.R. Number Name* DOB* Address* Postcode Telephone (H) (B) Mobile Medicare card* Concession card Clinical Notes EOS 2D / 3D X-Ray Request - All Erect Weight Bearing Full Body Length Full Spine and Pelvis AP/LAT Full Leg Length AP/LAT Full Spine Lateral Bending Left/Right Flexion /Extension Views - Cervical /Thoracic /Lumbar MRI Report AP/LAT CT Ultrasou.

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