Effective Immediately

Shared Health Diagnostic Services has released an updated standardized CT Requisition Form intended
for requesting Computed Tomography (CT) examinations to be performed at all facilities providing CT
service in Manitoba.

This updated clinical practice change memo aims to clarify the Diagnostic Imaging requisition process for
providers, improve wait times, and reduce double bookings and no-shows across Manitoba. The option to
select a specific site for your patient remains. If you speak with a radiologist, please write their last name
and site on the requisition (above the preferred site in the Outpatient section in the top left-hand corner).

The same requisition is to be used for ED/IP and outpatient exams. ED/IP exam workflows are different
than those for outpatients, and local practices in those setting are unchanged. The central intake routing is
only intended to apply to outpatients that are not time sensitive due to an acute medical process. For full
details on requesting exams to be performed in Winnipeg and outside of Winnipeg, see Requesting CT
exams section.

Emergent Requests:

For Diagnostic Imaging exams that need to be scheduled within one week, referring offices should contact
the preferred imaging site directly to arrange the appointment before sending the requisition. After
confirming arrangements with the Radiologist, fax the requisition to the imaging site and clearly note who
the arrangements were made with.

Do not fax time-sensitive requisitions to Diagnostic Imaging Central Intake, as it requires at least 24 hours
to process and forward them. The imaging site will schedule the patient. To prevent duplication and delays,
send requisitions to either the imaging site or Central Intake, not both. Time-sensitive exams should be
managed directly by the imaging site.

Requesting CT Exams:

Effective January 30, 2026, all urgent and elective requests for CT services to be performed in Manitoba
must be requested by submitting the standardized CT Request form R250-10-115 to:

• Exams to be performed in Winnipeg – Central Intake fax 204-926-3650 or 1-866-210-6119 All requisitions for out-patient CT, Ultrasound and Nuclear Medicine must go through Central Intake. This includes Winnipeg clinicians who are ordering exams to be done outside of Winnipeg.
• Exams to be performed outside Winnipeg – Nearest Diagnostic Imaging department providing CT service. Only requisitions for out-patient CT, Nuclear Medicine and US exams to be completed at a Winnipeg site must go through Central Intake. The process for requests coming from a rural site for completion of the exam at a rural site will remain the same, these referrals do not need to go through the central intake process. Please do not send duplicate requisitions to both the site and central intake.

Action Required:

• The Provincial EMR Support Services have the new CT requisition for their EMRs. The Form will also be available on the Shared Health website.
• Please use form SAP #299189 “Request for Diagnostic Imaging Exam” to request XR, US, NM exams to be performed in Winnipeg (sites affiliated with Central Intake). This form is also to be used for referring patients for DI exams from other areas in the province to facilities in Winnipeg.
• Please use form R250-10-116 DI Request for DI Examination (Rural) to request XR, US, NM
  exams outside Winnipeg (facilities NOT affiliated with Central Intake).
• Please discard printed and saved electronic copies of older Diagnostic Imaging requisitions.

The Relevant Clinical / Surgical History section MUST be completed and include relevant clinical history
AND if applicable, surgical history. It should never be blank or unreadable. Radiologists rely heavily on
clinical history to determine priority, scheduling and protocoling of each case.

All fields marked with an asterisk are required. If required information is incomplete or unreadable the
request form will be returned to the referrer. This may negatively impact the examination timeline.

References/Resources:

• Shared Health – Diagnostic Imaging Resources
• Shared Health – Diagnostic Imaging Central Intake
• New CT Requisition – Quick Reference Guide Document
• R250-10-115 CT Request
• R250-10-116 DI Request for DI Examination (Rural, non-MRI, non-CT)
• SAP#299189 DI Services Request Form (Winnipeg only, non-MRI, non-CT)

Printable version

Submitted by: Tamara Burnham, Collaborative Practice Lead