LXA Requisitions

Please note that we are an active Ocean eReferral site and all of our requisitions are available for ease of referral within Ocean or your EMR, if you are also an Ocean user.

PDF (only) Versions:

Re: MSK Image Guided Injections and Intervention Clinic  [Letter to Clinicians - July 2021]
  • MSK Requisition [PDF] (Rev. MAY 2021NEW!
    • We do prefer the use of Ocean to submit your MSK eReferral submissions as you have the option to include all relevant CPP [Cumulative Patient Profile] data for your patient. If you choose to submit an MSK referral via a hardcopy LXA MSK requisition, or use the provided fillable PDF above, please ensure that you are also including (attaching) all relevant patient history.

Telus PS Suite Form Versions:

Accuro Versions:

    Accuro formatted requisitions can be downloaded directly from within the Accuro Application.
  • General Imaging Requisition (Rev. 160519) - [This is an outdated requisition, please do not use. You can use the PDF version above or request hardcopy forms (pads) for use in your practice.]

  • Ultrasound and Echocardiogram Requisition (Rev. 160519)
  • Obstetrical Ultrasound - MFM Requisition (Rev. 071519)