Brockville General Hospital (Brockville GH)

• Brockville GH Diagnostic Imaging zip folder includes:

  • Bone Density Requisition/Questionnaire  (view PDF)

  • General Radiology-Fluoro Requisition  (view PDF)

  • Mammography Requisition  (view PDF)

  • Ultrasound-Echocardiography Requisition  (view PDF)

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Kingston Cardiology Associates (website) 

• Vascular Laboratory Referral zip folder

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Kingston Health Sciences Centre (KHSC) 

Hotel Dieu Hospital site (HDH)

• Audiology Referral zip folder  (view PDF)

• Breast Imaging Requisition zip folder  (View PDF)

• Chronic Pain Clinic Referral zip folder  (view PDF)

• Dysphagia Referral zip folder

• GI Function Testing Requisition  (view PDF)

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Kingston General Hospital site (KGH)

• KHSC CT Requisition  (view PDF)

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• Gastroenterology zip folder includes:

  • KHSC Gastroenterology Direct to Procedure Upper Endoscopy - Dyspepsia May2022.cfm​

  • KHSC Gastroenterology Direct to Procedure Upper Endoscopy - GERD May2022.cfm

  • KHSC Gastroenterology Liver Clinic Referral NAFLD Feb2022.cfm

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• KHSC General Internal Medicine Referral zip folder​  (view PDF)

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• General Surgery Referral zip folder​​​​​

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Kingston MRI

• Kingston MRI Requisition zip folder (view PDF)

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Limestone City Sleep Lab

• Sleep Disorder Referral zip folder  (view PDF)

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Lennox & Addington County General Hospital (LACGH) 

• Diagnostic Imaging zip folder includes:

  • Bone Mineral Density/Mammography (BMD/MAMMO)  (view PDF)

  • Computed Tomography (CT)​  (view PDF)

  • Echocardiography  (view PDF)

  • General Ultrasound  (view PDF)

  • Interventional Radiology (IVR)  (view PDF)

  • Obstetric Ultrasound  (view PDF)

  • X-ray  (view PDF)

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• Cardiac Diagnostic Services Requisition zip folder  (view PDF)​

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Limestone City Sleep Lab

• Sleep Disorder Referral zip folder  (view PDF)​

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Perth & Smith Falls District Hospital

• Diagnostic Imaging zip folder includes:

  • Ultrasound Request​

  • X-ray Request

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Providence Care Hospital (PCH) 

• Palliative Care Consult Team Referral zip folder (view PDF)

• Physical Medicine and Rehabilitation Outpatient Clinic Referral zip folder  (view PDF)

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Quinte Health Care  (QHC)

• Diagnostic Imaging Requisitions zip folder includes:

  • Bone Mineral Density (view PDF)

  • Breast Imaging - Mammo ​(view PDF)

  • Breast MRI (view PDF)

  • CardioPulmonary Services (view PDF)

  • CT (view PDF)

  • Interventional Radiology (view PDF)

  • Magnetic Resonance Imaging (view PDF)

  • Radiology X-Ray (view PDF)

  • Ultrasound (view PDF)

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South East Ontario Addictions & Mental Health Service (AMHS)

• AMHS Access Form zip folder

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