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Locations
All Branches
Clarence Valley Imaging
North Coast Radiology
Ballina
Byron Bay
Casino
Goonellabah
Lismore (North Coast Radiology)
Lismore (Northern Rivers Women’s Imaging)
Lismore (Nuclear Medicine)
Qscan (Qld)
Services
All Services
Bone Density (BMD)
DXA Body Composition
CT Scan
Dental Imaging
Interventions & Procedures
MRI
Mammography
Nuclear Medicine
Ultrasound
X-Ray
Patients
Support Centre
Appointment Bookings
Request Appointment
Upload referral
Change or Cancel Appointment
Patient Information Sheets
Understanding the Appointment Process
Patient FAQ
Billing & Payments
Medicare Information
Copies of Examinations
Patient Portal – access to images
Referrers
Online access to Results & Images (InteleConnect)
Doctor Portal – Online access to results and images
Referral Forms
E-Referrals
Diagnostic Imaging Pathways
Update/New Referrer or Practice Information
Software Downloads
Request or grant access to an examination
Medicare Guidelines
for Doctors
for Allied
About Us
Company Information
Our Radiologists
Careers
News
Contact Us
Contact Us
Compliments Suggestions Complaints
Patient Survey
Referrer Survey
Request Appointment
Change or Cancel Appointment
Careers
E-Referral BD
E-Referral BD Form
Patient Details
Patient Name
*
Date Of Birth
*
DD/MM/YYYY
Phone Number
*
Gender
*
Female
Male
Other
Patient Email Address
Booking Appointment
Radiology practice will call patient to arrange appointment
Patient will initiate appointment
BD - Items 12306, 12315 & 12321 - One service only in 24 month period - Item 12312 One service only in a 12 month period.
Item 12306 confirmation of a presumptive diagnosis of low BMD based on one or more fractures after minimal trauma
Item 12306 monitoring of low BMD proven by previous BD.
Item 12315 primary hyperparathyroidism
Item 12315 chronic liver disease
Item 12315 chronic renal disease
Item 12315 proven malabsorptive disease
Item 12315 rheumatoid arthritis
Item 12315 conditions associated with thyroxine excess
Item 12312 prolonged glucocorticoid therapy
Item 12312 conditions associated with excess glucocorticoid secretion
Item 12312 male hypogonadism, female hypogonadism lasting more than 6 months before age 45 years
Item 12321 measurement of BMD 12 months following a significant change in therapy for established low BMD
Item 12320 the patient has not previously had a BD, or
Item 12320 has had previous BD showing T-score of -1.5 or above
ROUTINE BMD includes all other indications. No Medicare Benefit applicable.
Exam details
Clinical details
Referring Practitioner
Referrer Name
*
Practice Email
*
PACS User or RIS ID
*
(Used to login to InteleViewer or Inteleconnect)
Provider Number
*
Practice Address
Copies to another referrer?
Yes
No
Copy to:
*
I am entitled under the Health Insurance Act 1973 (Cth) to make this request
Branch
*
Ballina
StVincents
Grafton
St Vincents is in Lismore & Qscan Ryde is in Sydney
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