Referral Forms

Right click on National Lung Cancer Screening Program Imaging Request image below to save pdf document to required location. Complete required form fields, print and fax to the corresponding site location, numbers located on the back of the request form.

HOW DO I REFER PATIENTS TO THE National Lung Cancer Screening Program (NLCSP)?

IMAGING REQUEST FORM

• Available in hard copy and electronic versions
• Must be the NLCSP version (Ensures correct prompts and patient tracking)

REPORTS TO:

• National Cancer Screening Register (NCSR) – One electronic record per person in Australia

COVERS:

• National Bowel Cancer Screening Program
• National Cervical Screening Program
• National Lung Cancer Screening Program

WHY THIS MATTERS

• Prompts lung screening reminders
• Supports clinical decision-making
• Flags Quantum Medical Imaging that it’s part of NLCSP

Always use the dedicated NLCSP request form, this ensures correct workflow and supports ongoing screening initiatives

NO COST TO THE PATIENT
Medicare will cover two new MBS items:

• The screening low dose CT scan undergone by the participant every 2 years
• The interval low dose CT scans for any follow-up needed during the 2-yearly screening period (as required, following results of the screening low dose CT scan).

These will be mandatory bulk billing items and will have mandatory reporting requirements.

WHY CHOOSE QUANTUM MEDICAL IMAGING?
Quantum Medical Imaging is a proudly independent, community-based radiology provider committed to putting patients first. We offer expert care, modern technology, and accessible imaging services across four convenient locations.