Non-Emergent Referrals
The “Request for Consultation for a Diagnostic Imaging Exam” form (requisition) is completed by a referring clinician and faxed to Central Intake. Requisitions are then faxed to one of the Shared Health diagnostic imaging facilities based on the shortest wait time for the requested exam.
Modality specific intact is listed below:
| Modality | Intake Options |
|---|---|
| X-Ray | – Walk up service – Hours of operation are site specific |
| Breast Imaging | – Direct requisition to site of choice – Do not send to Central Intake, excluding Breast MRI |
| Fluoroscopy | – Direct requisition to site of choice |
| MRI | – Central Intake for all MRI request |
| Ultrasound | – For Winnipeg clinicians or for request to be performed in Winnipeg all requisitions are to be sent to Central Intake. – For Rural clinicians requesting a rural location (NRHA, IERHA, SHSS or PMH), direct requisition to site of choice. |
| CT | – For Winnipeg clinicians or for request to be performed in Winnipeg all requisitions are to be sent to Central Intake. – For Rural clinicians requesting a rural location (NRHA, IERHA, SHSS or PMH), direct requisition to site of choice. |
| Nuclear Medicine | – Central Intake or Brandon |
Diagnostic Imaging Hours and Locations
Hours and locations are available here.
Referral Forms
MRI
- MRI Requisition
- Reference Guide (mandatory fields example)
- MRI Safety Checklist
- Pediatric pre-sedation history and physical
- Choosing Wisely Lumbar Spine Form
- Choosing Wisely Lumbar Spine patient information
CT
- Diagnostic Imaging Services Requisition Form (Non-MRI)
- Reference Guide CT example requisition
US
- Diagnostic Imaging Services Requisition Form (Non-MRI)
- Reference Guide US example requisition
X-ray
- Diagnostic Imaging Services Requisition Form (Non-MRI)
- Reference Guide X-ray example requisition
Breast Imaging (mammography)
Nuclear Medicine
- Diagnostic Imaging Services Requisition Form (Non-MRI)
- MPI form
- Brandon
- St Boniface
- Health Science Center
Note:
- Lack of pertinent data MAY DELAY the referral process along with scheduling of the patient’s appointment.
- Requisitions that are illegible will be returned.
- The site will triage the patient requisition and create an appointment.
The patient will receive a letter in the mail identifying their appointment time, date and any necessary preparation instructions.
On a daily basis, referring clinicians will receive a faxed list identifying which patients were scheduled for appointments, and their subsequent appointment date and time.