Patient Referral Form

Patient Referral Form Download

When referring patients to our specialist lung screening, please use the following form:

LSA Patient Referral Form 2021

Lungscreen online referral form

The preferred way to refer a worker for an X-ray is using Lungscreen’s online referral form generator. Referrers can do this by logging in to your Lungscreen account to complete the referral form online.

Online referral registers the job in the Lungscreen system and ensures the Lungscreen ID is on the X-ray referral form, which the imaging clinic must embed in the X-ray DICOM® image file header.

When the image is received by Lungscreen, all the information about the worker and the referral is already in the Lungscreen system, and manual handling is not required to update needed information. This will significantly reduce the risk of any delays.