View MoH Eligibility Guide here
Form to be printed and signed, patient to take this form to appointment
Due to Covid 19 restrictions, this patient is unable to be scanned in primary care at a community radiology provider.
Please discuss with local DHB radiology or discuss with on-call hospital speciality for an appropriate management plan.
For more information visit the Ministry of Health website here
Thank you for your understanding and cooperation.
FOR POAC USE: