Description

Our request forms have evolved in response to specific requests from our referrers. Following is an overview of the three main versions. Sample images of the forms are available below. They can also be printed out from your browser window. If you would like to give your patient specific scan information on Bone, Myocardial Perfusion or Bone Densitometry scanning please request them from your nearest SNIG practice. Or simply click here for an electronic copy. SCAN INFORMATION BROCHURES.

1. The OLD Forms No longer available.

2. The New Forms For handwritten requests.

3. A4 Request Forms for use with Medical Director For use in your computer's printer.

4. A4 Request Forms for use with Other Practice Managements Systems

1. The OLD Forms

The Southern Nuclear Imaging Group request forms used up until the end of 1999 are made up of two parts.

Firstly, the white (top) copy, is the part to be filled in by the referring doctor. It requests patient information, clinical details, information about the referring doctor and allows the referring doctor to request an urgent telephone report if required.

The second page (blue) is an information sheet which should be given to the patient (with the completed white form). It has space for the appointment times and has other important information regarding preparation an practice locations.

The Sydney based practices share the same form. This gives the patient an option between attending either the St. George or Bankstown rooms. care should be taken that the location at which the scan is booked is the one that the patients attends.

Both Illawarra and Shoalhaven have their own forms.

2. The New Forms

Commencing at the end of 1999 and for completion in January 2000, new improved request forms (with a reference to this web site) were distributed. The original forms could be used at any one of our 4 practices. At the end of 2000 and early in 2001 the forms were changed. The most recent forms have site information for either the Sydney based practices (Kogarah/Bankstown) or those to the south (Illawarra/Shoalhaven).

3. A4 Request Forms for use with Medical Director

We now can supply an A4 form printed which can be used to print out requests for SNIG procedures directly from Medical Director. They will contain all of the information on our current forms but will be formatted to allow printing directly from the referring doctor's computer (running Medical Director). They follow the generic template used by South Coast X-Ray in the list of Imaging Providers.

Directions for Setting up Medical Director  to Use Our A4 Forms (In Adobe format)

4. A4 Request Forms for Use with other Practice Managements Systems

The Medical Director request forms are set up especially to work with Medical Director with the various print areas set. Other Patient/Practice Management systems print to a blank sheet of paper and therefore overlap with the printed A4 forms. With this in mind we have available forms with information about SNIG and other relevant information on one side and a blank area on the other. So, simply print out the patient details etc on the blank section and the site, procedure, location, contact details and related information is on the reverse. Please request them from your nearest Southern Nuclear Imaging Practice.

Image to follow.

Custom Designed Forms?

With the development and use of computers within many practices some referrers like to have electronic request forms (other than Medical Director) which they can create and then print out from their desktop or Lap-top computer. Please ensure that the patient also receives an equivalent of the information and location sheets. Information sheets can be printed out by clicking on one of the images above and printing from the browser window.