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:
- General Imaging Requisition [PDF] (Rev. MAR 2020) Updated!
- Ultrasound and Echocardiogram Requisition [PDF] (Rev. 160519)
- Obstetrical Ultrasound - MFM Requisition [PDF] (Rev. 071519)
- OBSP Appointment Date and Time Card [PDF]
- Patient Auth for Release of Information - InteleConnect
- MSK Requisition [PDF] (Rev. MAY 2021) NEW!
- 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:
- General Imaging Requisition [CFM] (Rev NOV 2019) Out of Date!
- Ultrasound and Echocardiogram Requisition [CFM] (Rev. 160519)
- Obstetrical Ultrasound - MFM Requisition [CFM] (Rev. 071519)
- Information on how to import custom forms into PS Suite can be found here. PS Suite EMR: Importing Custom Forms
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can be downloaded directly from within the Accuro Application.- General Imaging Requisition (Rev. 160519) - [This is an outdated requisition, please do not use.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)
- Information on how to download these forms into your Accuro, please click here.