Request or grant access to an examination

Request one-time access to specific patient or study

Request a copy of a specific examination result (images or report) for a patient in your care. You can also grant access to another provider.


Requests from Public hospitals for PACS transfers need to complete this PDF form. If there are any issues with this transfer, please call Lismore Base Hospital Radiology Department on 02 6620 2456.


Patients can also initiate a request via the Patient Support; ‘Copies of Examinations’ form.

(Note we do not send reports or images via email)

Referrer Information

(Including area code)
(Including area code)
(Userid you use to login to Inteleconnect or Inteleviewer - if you do not have one enter 'One time access')
Destination Hospital *

Multiple studies

Maximum upload size: 20.48MB
(List must include Surname, Firstname, DOB - optionally accession #, date & description of examination, patient ID)

Single Examination / Study Information

(first name & surname)
(starts with NA at top of validated report)

Grant access to another provider

Consent and Sign off

Maximum upload size: 20.48MB
Please use your mouse to sign this form