DI and MRI Request for Consultation

Cambridge Memorial Hospital now accepts physician eReferrals directly from our website:

Diagnostic Imaging eRequisition Form
(for x-rays, mammogram, bone densitometry, CT, ultrasound and nuclear medicine)

MRI eRequisition Form

You may also send an eReferral to us using the local health service directory OceanHealthLinks.ca.

For Telus Practice Solutions EMR users:
Please see below to download custom forms that send eReferrals directly to CMH from your PS Suite EMR (with no additional login required).

PS Custom Form for Ocean eReferrals:  (needed by both DI and MRI forms)
https://s3.amazonaws.com/ocean.pss/Ocean+eReferral.cfm   (right click -> Save As to download the file)

PS Custom Form for Diagnostic Imaging eRequisition:
https://s3.amazonaws.com/ocean.pss/CMH+Diagnostic+Imaging+eRequisition.cfm (right click -> Save As to download the file)

PS Custom Form for MRI eRequisition:
https://s3.amazonaws.com/ocean.pss/CMH+MRI+eRequisition.cfm (right click -> Save As to download the file)

Click here for installation instructions.
Note: please ensure that you install all three custom forms in your clinic before attempting to send a referral.

For other EMR users or those without an EMR:
If you do not wish to send an eReferral, faxed referrals are still acceptable.
DI Referrals (DI Requisition) can be faxed to (519) 740-4904
MRI Referrals (MRI Requisition) can be faxed to (519) 740-4969

E-Referral Support:
If you require assistance with your e-referral, please contact us.
E-mail:   ereferralsupport@cmh.org
Diagnostic Imaging:  (519) 621-2333 ext 2230
MRI:  (519) 621-2333 ext 4968