FOR OFFICE USE ONLY Protocol: Priority 1 CT REQUISITION Department of Medical Imaging 4001 Leslie Street Toronto, Ont M2K 1E1 CT Booking Office Tel 416.756.6190 Fax 416.756.6192 2 3 4 Special Codes.

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How to fill out the North York General Hospital Ct Scan Requisition online

Filling out the North York General Hospital Ct Scan Requisition online can be a straightforward process when you understand each section of the form. This guide will provide you with detailed instructions to ensure that your requisition is completed accurately and efficiently.

Follow the steps to complete your requisition form successfully.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In the first section, indicate the CT exam requested by filling in the appropriate details. This is a crucial step as it determines the type of imaging needed.
  3. Complete the 'Relevant Clinical Findings' section. This part must be filled out thoroughly to provide the medical team with important information about the patient’s condition.
  4. Fill in the referring physician's name and signature along with their medical license number. This information helps verify the request and maintain proper communication.
  5. Provide the patient's creatinine level and eGFR, making sure to include the date drawn. This is required within 90 days prior to the scan, particularly for certain patient groups.
  6. Indicate if the patient is diabetic by checking 'Yes' or 'No'. If 'Yes', list any medications the patient is taking.
  7. Check whether the patient has had a previous contrast reaction, and if 'Yes', provide details. This information is critical for ensuring patient safety.
  8. Indicate if there are any relevant prior exams that should be considered. If the patient is under 30 years of age, previous reports must be included.
  9. Determine if the patient speaks English. If 'No', it is advisable to arrange for an English-speaking interpreter to assist during the appointment.
  10. Once all sections are complete, you can save changes, download, print, or share the form as needed.

Complete your North York General Hospital Ct Scan Requisition online to ensure seamless processing.

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