Diagnostic Imaging Resources

• Diagnostic Imaging Services Requisition form (non-MRI)
• Request for DI Examination (Rural) (R250-10-116)
• Fax contact sheet
• CT Request Form
• MRI Request Form (R130-80-04)
  • Pediatric pre-sedation history & physical
• Pediatric Electrocardiogram Requisition
• PET Neurology physician referral form
• PET Oncology physician referral form
  

Bone Mineral Density – NEW
Shared Health has released a standardized Bone Mineral Density (BMD) Requisition Form to be used at the two participating sites (St. Boniface General Hospital & Brandon Regional Health Centre).

• Standardized Provincial Bone Mineral Density
• New BMD Request Form

CT
Shared Health has released a standardized CT Requisition Form. Effective January 30, 2026, all urgent and elective requests for CT services to be performed in Manitoba must be requested by submitting the standardised CT Request form R250-10-115.

• The new request form, reference guide and more can be found on our Central Intake webpage
• Standardized Provincial CT Requisition Clinical Practice Change
• CT Requisition Form Quick Reference Guide
• Outpatient CT Walk In at Misericordia Health Centre