The Diagnostic Imaging Request Form is used to request radiology and nuclear medicine investigations. It supports requests for imaging such as X-ray, CT, MRI, PET-CT, ultrasound, and interventional procedures. The form captures essential patient details and clinical information required to support appropriate imaging requests. Completing this form in Heidi supports clear, complete documentation and assists clinicians in submitting compliant imaging requests in line with regulatory and departmental requirements.
The purpose of the Diagnostic Imaging Request Form is for a referring clinician to submit a request to a health service's diagnostic imaging or nuclear medicine departments for an investigation. It is a legal document under UK regulations that captures essential patient details and the clinical information required to justify an imaging request. The form supports requests for X-ray, CT, MRI, PET-CT and ultrasound. It also serves as the referrer's declaration that the request is justified, the patient details are correct, pregnancy has been considered and there are no known contraindications.
You use the Diagnostic Imaging Request Form as a referring clinician within a health service's catchment area in the UK. This includes GPs, hospital consultants, specialty trainees and nurse practitioners who are registered referrers. When you complete and sign the form, you are taking legal responsibility for the request. If you are signing on behalf of a responsible consultant, that consultant's name, GMC number and contact details must also be recorded on the form to complete the submission.
A Diagnostic Imaging Request Form PDF includes patient identification, the investigation requested, safety screening questions and the referrer's declaration.
The form is a legal document, and your signature is a declaration that the patient's details are correct, pregnancy has been considered, the request is justified and there are no contraindications. A simple administrative error, like incorrect patient details or a missed safety question, becomes a regulatory issue under UK medical exposure regulations. This elevates the risk of routine documentation slips, as an inaccurate form can lead to a formal query from the radiology department and a delay in the investigation.
A vague clinical summary, like "CT abdomen for pain," is not sufficient to meet the justification standard required by regulations and will be queried by the receiving department. The form requires a clear clinical question, indication for the study and purpose of the investigation. For oncology imaging, it also requires details like history of malignancy, biopsy results and treatment dates. Assembling this specific information for every request, while managing a busy clinic, is a frequent point of friction.
The form combines requests for multiple imaging types, each with its own safety checks. It is easy to overlook the specific blocks that are not relevant to your immediate request, but missing a key detail in the ones that are relevant will cause delays. Forgetting to check the seven MRI safety questions, missing a recent eGFR for a contrast study or failing to note patient transport needs are common omissions that require the radiology department to call you back for clarification.
You have the patient's identity and pregnancy status documented in the chart, but transcribing them onto a separate form introduces the risk of error. Heidi pre-populates the patient's demographic details and surfaces their pregnancy status, last menstrual period and breastfeeding status from the structured profile. This provides a correct and complete starting point for the form, ensuring your legal declaration about patient details and pregnancy consideration is based on documented information.
Finding and transcribing every safety detail for MRI, contrast or interventions is time-consuming and prone to error. Heidi pulls the patient's most recent eGFR, device history, allergies and anticoagulant status directly from their record to pre-fill the relevant safety blocks. Instead of hunting for data across multiple systems or leaving fields blank, you start with the answers, which you review and confirm before the request is finalized.
Writing a clinical summary that meets the legal standard for justification can be challenging at the end of a busy session. Heidi transcribes your visit and structures the free-text clinical summary to include the indication, clinical question and relevant history needed to satisfy the justification requirement. For oncology requests, it pulls forward the patient's malignancy history, biopsy results and treatment dates to support the specific request, giving you a complete draft to review.
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