Forms

This section is for Non-Medical colleagues who refer or would like to be able to refer patients for imaging at DCH.

To apply you will need to complete an application form and return it to NMR@dchft.nhs.uk You will also need to book onto IRMER training.

Please note before applying that we only accept applications from NMRs who have at least two years’ experience post registration.

Your application will be reviewed by the NMR governance team who may request to discuss your application with your delegating clinician or clinical lead before agreeing your protocol.

Once your application has been accepted and IRMER training attended you will then receive your signed entitlement to refer.

Please note there is a legal requirement for you to have a separate documented entitlement with each Trust that you refer to. 

All NMRs for diagnostic imaging must:

• Refer within their defined protocol and specified requesting agreement
• Adhere to the NMR responsibilities
• Have initial IRMER training and maintain three yearly refresher updates
• Submit an audit of compliance every two years (first audit will be due after one year)
• Request more than five exams per annum to justify this requirement
• Once the clinical report is available the referrer has a duty to act upon the results, within their clinical context.

Complete your application form.

If you need support with filling out the application form, please read the instructions for completing the NMR PDF application form. You can also email us at NMR@dchft.nhs.uk

Any future changes to your lead clinician will require you filling out the Change of Delegating Clinician Form.

Any requests to amend your inclusion criteria will require a new application form.