Diagnostic Services Forms

Requisition Forms

Name

Number

Language

Outpatient Requisition X-Ray/ Ultrasound / Mammography RHC 204 English
Outpatient CT Scan Consultation Request RHC 607 English
Tissue Requisition RHC 691 English
Transfusion Medicine Requisition RHC 779 English
Cardiorespiratory Services Requisition (ECG/Holter Monitor/Stress Testing) RHC 1107 English
Nuclear Medicine Requisition RHC 1109 English
Electroencephalograph Requisition RHC 1155 English
MRI Requisition RHC 1243 English
Bone Mineral Density Requisition RHC 1946 English
Cytology & HPV Testing Requisition RHC 2425 English
Outpatient Echocardiography Requisition RHC 2915 English

 

Questionnaires

Name

Number

Language

MRI Screening Information Form RHC 1241 English

 

Patient Information Forms

Name

Number

Language

Barium Enema – Outpatient RHC 229 English
Semen Fluid Analysis Collection Instructions RHC 270 English
Stream Urine Collection Instructions RHC 271 English
Stool Collection for C&S (Cary Blair with Indicator) RHC 860 English
Midstream Urine Collection Instructions for Cytology RHC 952 English
24 Hour Urine Collection Instructions RHC 954 English
Sputum Collection Instructions for Cytology RHC 971 English
Stool Collection Instructions for Clostridium Difficile RHC 975 English
Sputum Collection Instructions for Culture and Sensitivity RHC 2039 English
Stool Collection Instructions for Occult Blood RHC 2040 English
Glucose Tolerance Testing Collection Instructions RHC 2683 English
Patient Instructions For Intravenous Contrast Extravasation RHC 2954 English
Random Urine Collection Instructions RHC 3098 English

 

Pre-Printed Physician’s Orders

Name

Number

Language

Therapeutic Phlebotomy PPO-6-074 English

 

Other Forms

Name

Number

Language

Adult Transthoracic Echo Final Report RHC 2904 English

North Bay

50 College Drive,
P.O. Box 2500
North Bay, ON
P1B 5A4
Tel: 705-474-8600

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Sudbury

680 Kirkwood Drive,
Sudbury, ON
P3E 1X3
Tel: 705-675-9193
Fax: 705-675-6817

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Floor Plans

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Visitors Guide

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