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Update Referrer or Practice Information

Update practice or referrers & Online Account applications

Use this form to:

 

Register a new practice, add or remove a referrer at an existing practice – this is important to ensure we have correct information and reports and images can be provided in the format/s you need.

 

Change details about your practice or close a practice. This is important if you are moving premises or have some changes that we need to know about as they can impact on delivery of results.

 

Request an online account to enable electronic access to both reports and images for your patients who have visited one of our branches.

 

To better understand the various options for the format and delivery of reports and images please click here.

 

To download a form click here.

 

If you do not already have Medical Objects delivering reports for your practice and want to receive reports electronically click here. Once completed print and fax the form directly to Medical Objects using the fax number on the form or scan in and email to register@medical-objects.com.au

(Date change to take effect)

Current referrer details

Referrer details

(New or revised details)
You must already be in our system before you can get an online account. If not please select the New Referrer option.
(Including title e.g. Dr John Smith)
This is the Phone number for our Radiologists to use for medically urgent contact
(or practice email account)
(incl Area Code)
Practice Name, Address, State, Postcode

Current practice

Practice details

(eg Main Street Medical Centre or Dr Smith's Rooms)
(Primary Type of Practice)
(including area code)
(including area code)
Practice Manager or similar

Report and Image preferences for Referrer

Please identify the diagnostic imaging and report requirements. For more information click on the link to the left of this form.
You can choose more than one method. Online Portal is via a secure website. Inteleviewer is software installed on your computer (MAC or PC).
Images required in Film or Printed format ​will be given to patients due to their size.
Images required in Film or Printed format will be given to patients due to their size.
An online account is required for access to Inteleviewer and/or Online Portal. To access Portal copy this link into any browser: https://iv.ncrad.com/Portal/app or click on Online Access to Results & Images under Referrer Support menu.
Inteleviewer delivers superior viewing quality and image functionality. Suited to those who are interested in viewing, comparing and analysing comprehensive image series from any modality examination for their patients. Diagnostic Imaging Reports are also available through Inteleviewer. Requires Online Account.
(Could be special report / image delivery requirements)

List of referrers

(Please include title in name e.g. Dr John Smith)
Drop a file here or click to upload Choose File
Maximum upload size: 52.43MB
(If you have more referrers please create list and upload as PDF file)

Report & Image preferences for the practice

Please identify the diagnostic imaging and report requirements for your practice. For more information click on the link to the left of this form.
Is your practice filmless and paperless?
You can choose more than one method. Download is a secure delivery of the report into your practice software by Medical Objects. Online Portal is via a secure website. Inteleviewer is software installed on your computer (MAC or PC).
You can choose more than one method. Download is a secure delivery of the report into your practice software by Medical Objects. Online Portal is via a secure website. Inteleviewer is software installed on your computer (MAC or PC).
Images required in Film or Printed format cannot be mailed out.
Images required in Film or Printed format cannot be mailed out.
An online account is required for access to Inteleviewer and/or Online Portal. To access Portal copy this link into any browser: https://iv.ncrad.com/Portal/app or click on Online Access to Results & Images under Referrer Support menu.
Inteleviewer delivers superior viewing quality and image functionality. Suited to those who are interested in viewing, comparing and analysing comprehensive image series from any modality examination for their patients. Diagnostic Imaging Reports are also available through Inteleviewer. Requires Online Account.
Specify How you would like to receive the additional paper copies of the validated examination report
(These could be re delivery of reports and images. Note you can have specific referrer notes and delivery options.)

Electronic account setup

(Contact account rep for details or check out web page Digital Solutions under Referrer Support in menu)

Electronic delivery of report

Deliver reports to your practice management system eg Best Practice, Medical Director, Genie etc.
Secure Downloads send validated Radiology reports directly through to the results area of your Patient Management Software. It is a suitable mechanism for anyone who expects to be receiving reports regularly through the week.
(e.g. Windows 7, Windows Server 2008, OSX Leopard)
Please indicate which items your practice has available (if any)

Your IT Support

Drop a file here or click to upload Choose File
Maximum upload size: 52.43MB
(Upload jpeg or PDF files such as confidentiality form)

Sign off

This practice, its staff, consultants and agents agree to comply with the Health Records & Information Protection Act 2002 and other relevant Privacy laws as well as the NCRG Privacy Policy. NCRG is requesting this information from you so we can provide our diagnostic imaging service and associated functions to you. For more information on our privacy obligation visit www.ncrad.com.au or speak with our Client Support Officer. When you tick Yes to agree the Policy below will disappear.

NCRG Privacy Policy

Images and reports from North Coast Radiology Group (NCRG), which includes North Coast Radiology, Clarence Valley Imaging, Chatswood Radiology and Ryde Radiology can be accessed by authorised users. There are three categories of authorised users

  • NCRG staff have access to the patient information required to carry out their duties.
  • Referring health service providers have access to the images and reports arising from their referral of their patient.
  • Other registered medical practitioners and specialists involved in the treatment or care of the patient, where required for that treatment or care.

To become an authorised user, health service providers need to complete this form. If approved, NCRG will contact you once you have been set up on the system.

Application form

Privacy law requires that NCRG ensures that any access to its health records is restricted to authorised people and for justified medical diagnostic or treatment purposes only. NCRG also needs to protect its electronic systems and networks from viruses, other malware and unauthorised access.

Every individual who wishes to access NCRG's PACS must sign this document, agreeing to comply with certain restrictions and to act in a way that maintains privacy for our patients, referrers and staff, and security of our information systems. You will also be agreeing to NCRG conducting regular audits of any or all episodes of external access to its PACS, for the purpose of monitoring compliance.

Agreement:

I hereby request access to NCRG's PACS. I agree to comply at all times with NCRG's rules related to the security and privacy of its electronic records. I will keep my username and password absolutely confidential. I will act responsibly to maintain the security and integrity of the information systems that I use, so as to minimise the chance of any problems or security breaches for NCRG.

I will only look at my patients' medical imaging records for the purpose of providing diagnostic or treatment services to them and not for any other reason. I will ensure that unauthorised people cannot gain access to confidential information. If I need to copy or print images or other information from the NCRG PACS, I will also treat them as confidential medical records. I agree to comply with any audit by NCRG or its agents of access to the NCRG PACS. I understand that as a health service provider I am also bound by and subject to the provisions of the Privacy Act 1988 (Cth), and the Health Records and Information Privacy Act 2002 (NSW).

Complete

Please use your mouse to sign this form

Download Confidentiality form HERE to complete manually.