Diagnostic Requisitions - Physicians only
This page is designed to allow physicians electronic access to the most current Diagnostic Imaging requisitions.
These requisition forms are for physicians to complete only. They are not intended for patients to complete.
No Diagnostic Imaging exam will be performed at any QHC hospital without a fully completed requisition signed by a licensed physician. Any requisition that appears fraudulent will be investigated immediately and imaging services WILL NOT be provided.
- Breast Imaging Requisition
- Breast MRI requisition
- Cardiopulmonary Requisition
- CT Requisition
- CT Colonography Requisition
- CT Cardiac requisition
- External Imaging Consult
- Interventional Radiology Consultation
- MRI Requisition
- Nuclear Cardiology Requisition
- Nuclear Medicine Requisition
- Radiology, BMD Requisition