Medical Imaging / Radiology

All referral forms on this website are also available as eForms for OSCAR, Avaros, Indivicare, and ACCURO EMRs. You can download some of the premade forms here from WorldEMR or fill the contact form below for any other eForms that are not listed for your EMR.

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LocationForms
MRI and CT (same form for entire SW LHIN region)MRI – Regional Referral (LHSC, SJHC, Woodstock, Owen Sound, Stratford)
—Regional MRI Requisition & Spine Appropriateness Checklist (must accompany referral)
—Regional MRI Requisition & Knee Appropriateness Checklist (must accompany referral)
CT – Regional Requisition
—Regional CT Requisition & Spine Appropriateness Checklist (must accompany referral)
London Health Sciences CentreLHSC Ultrasound Requisition
LHSC Nuclear Medicine
St. Joseph’s Health Care  SJHC Ultrasound Requisition
SJHC Nuclear Medicine Requisition
SJHC PET CT Requisition
SJHC Breast Assessment Form

SJHC Radiology – OSCAR eForm
Huron Perth Healthcare Alliance (Stratford, St. Marys, Clinton, Seaforth)HPHA Imaging (Xray, BMD, US) Requisition
HPHA Breast Imaging Requisition
HPHA Nuclear Medicine & DEXA Requisition
HPHA Outpatient Image Guided Biopsy and Drain Requisition
Middlesex Hospital Alliance (Strathroy, Four Counties Health Services)MHA Imaging Requisition
MHA Breast Imaging & BMD Requisition
St. Thomas Elgin General HospitalSTEG Imaging Requisition
STEGH Ultrasound Requisition
Woodstock General Hospital)Woodstock X-ray Requisition
Woodstock Ultrasound Requisition
Woodstock Cardiac Investigation Requisition
Woodstock Breast Imaging Requisition
Woodstock BMD Requisition
Woodstock Nuclear Medicine Requisition
Woodstock Transrectal Ultrasound Requisition
South Huron Hospital Association (Exeter)SHHA Imaging Requisition
SHHA Imaging Preparation Instruction Sheet
London X-Ray AssociatesLXA General Diagnostic Imaging Requisition [OSCAR eForm]
LXA Ultrasound & Echocardiograms Requisition [OSCAR eForm]
LXA Obstetrical Ultrasound Clinic / Maternal Fetal Medicine Clinic (OBMFM) Requisition [OSCAR eForm]

MyHealth CentreMyHealth London Requisition
MyHealth Arva Requisition

Need eForms for your EMR system? EMR training? IT services? Online booking? Check-in kiosk? Contact us
Get all the London-area eForms for OSCAR, JUNO, Avaros, THT, Indivicare here
Contact [email protected] for any other eForm needs for OSCAR, JUNO, Avaros, THT, Indivicare, and Accuro EMRs.