Complete this form to request clinically urgent scans required within 24-48 hours of assessment. Routine ultrasounds should be arranged in the normal way to ensure those in high clinical need are prioritised.
By completing this form the referrer confirms that the referred is eligible for maternity health services under Section 88, and is scheduled to birth in a Counties Manukau facility.
Please note this request form can be used as the radiology request form and a separate form is no longer required.
If not already completed you can request a co-payment funding voucher here