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Diagnostic Neurophysiology (EEG/EMG) Referral


Referrals form

Referrals process

1Download the correct requisition form 

Download the correct requisition form, depending on the type of test you want conducted: 
  • Electroencephalography (EEG) 
  • Electromyography (EMG) & Nerve Conduction 
  • Evoked Potentials

2For an EEG, give the reason for requesting the test  

On the EEG requisition form, give the reason for requesting the EEG. You may check as many as apply.

To Determine:
  • If event(s) are seizures
  • Seizure type
  • Epilepsy syndrome
  • Subclinical seizures
  • Non-convulsive status
  • New seizure type
To Evaluate:
  • Seizure control follow-up
  • Change in medication
  • Recurrence or increase in seizures
Other:
  • Repeat EEG for sleep
  • To capture an event
  • Decreased level of consciousness – undetermined cause
  • Encephalopathic
  • Other

3If you need a fast EEG report 


Your office can obtain faster EEG results by receiving a faxed report.

Physicians’ offices can contact us for more information by calling 604-875-2124.

 
Referrals
SOURCE: Diagnostic Neurophysiology (EEG/EMG) Referral ( )
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