Referrals & Requisition Form
Referring a Patient:
There are 3 available options for referring patients to our clinic:
1. PDF Requisition
Click on your clinic below to download a PDF of our requisition that can be used at any of our sites:
2. EMR E-Form Requisition:
- Open Accuro and select the Accuro “Bullseye” (red icon at bottom-left of the screen).
- Click “Tools” then “Form Editor”. A new box will pop-up.
- Click “Tools” very top left corner again then “Publish/Download”.
- Search for the Valence Medical Imaging requisition (one universal requisition for all Valence locations). The Publisher should be “Valence Medical Imaging”. The requisition is also searchable with other key words including: xray, ultrasound, Heartlake, Kennedy Eglinton, Lawrence Bathurst, Bloor Christie, Whitby, and Niagara Falls.
- Click “Preview” as needed then click “Download” to complete.
- Log into IndiviCare and click the “Admin” menu, scroll to the eForms section and click “Upload eForm”.
- Click “Import eForm”.
- Click “Browse” to find the first .zip file (Valence Medical Imaging p1.zip), select this file and click “Open”, then click “Import”.
- Repeat Step 3 for the second .zip file (Valence Medical Imaging p2 .zip). (The front and back of the requistion has been kept as 2 separate forms).
Once Steps 1-4 are completed, please have an administrator test out the new form (pages 1 and 2 separately) by using a test patient.
If you have a faxing function set-up, there is a second step to add Valence Medical Imaging as a fax destination. This will allow you to select Valence Medical Imaging from the drop-down menu at the bottom of the e-form (page 1 only) and fax the form directly.
Adding Valence Medical Imaging as a “Specialist” (Fax Destination)
- From the Con menu, clinic “Edit Specialists Listing”, then Add Specialist.
- Add Valence Medical Imaging contact information (address, phone number and fax number are all mandatory) for the chosen Valence location.
- Enter “Centre” as the last name, “Valence Medical Imaging” as the first name, and click “Add Specialist”.
- Click “Show All Services”, scroll as needed, and click “Radiology”.
- Scroll to “Valence Medical Imaging” and click the checkbox, then scroll back to the top and click “Update” these Service Specialists.
- Valence Medical Imaging is now available as a fax destination and appropriately associated under Radiology in your system.
If you have any support requirements or enquiries regarding retrieving/uploading this IndiviCare eForm please contact the Support Team at [email protected].
- Open Oscar and click the “Administration” tab (user login must have administrative access).
- From the side menu, click the “Forms/eForms” tab then “Upload an Image” from the sub-tab.
- Click “Choose File” and locate both JPG and the eform.properties.js files saved on the desktop from the previous step.
- Upload all 3 files one by one selecting the file then clicking the green “Upload” button to complete.
- Next click on “Manage eForms” then “Upload” located beneath the “eForms Library” title.
- Before choosing the file to upload, title the form, ask the physician’s office if they prefer to see our company name first or “Valence Medical Imaging”.
- Click the “Choose File” locate the HTML file from the desktop and click “Upload” to complete.
- Once completed, have the reception staff quickly test out the new form using a test patient.
These two .zip files (Zip1, Zip2) can be used to validate the eForms and instructions.
Alternatively, any OSCAR Pro customer can send a request to their standard support address [email protected] and request that the Valence Medical Imaging eForm be added to their system.
If you have a faxing function set-up, there is a second step to add Valence Medical Imaging as a provider. This will allow you to select Valence Medical Imaging from the drop-down menu at the bottom of the e-form and fax the form directly:
- Click on “Consultation” at the top of the Oscar homepage.
- Depending on your version of Oscar, either “Add Provider” or “Add Specialists” should appear. Here you can add Valence Medical Imaging contact information (address, phone number, fax number).
- Enter “Centre” as the last name and “Valence Medical Imaging” as the first name and click “Save”.
- Click “Edit Specialists Listing” and then click “Radiology”. In the list of specialists, select the check-box for “ValenceMedImgp1″ and “ValenceMedImgp” and then click “Save or Update these Services Specialists”.
- Valence Medical Imaging is now appropriately associated under radiology in your system.
You may have noticed that our requisition form is now available in TELUS EMRs!
To access the Valence Medical Imaging Requisition form (one universal requisition for all Valence locations), simply search the form in your Med Access or PS Suite central forms library. The DI form is searchable by typing in “Valence” in your forms library.
Add it as a favorite form to locate it easily.