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Order Forms

If you are a referring physician and want to order imaging exams, our friendly, professional scheduling staff will pre-certify and schedule your patients for the following procedures:

  • CT
  • MRI
  • PET/CT
  • Nuclear medicine
  • Interventional radiology

Orders for exams and procedures at our Lawrenceville, Duluth or Hamilton Mill locations can be placed via phone or fax.

  • Phone: 678-312-3444
  • Fax: 678-312-9736

If you are an on-staff physician at Northside Hospital Gwinnett or Northside Hospital Duluth and would like access to PACS (Picture Archiving Communication System), contact Imaging Physician Relations at 678-312-5344. Please note that only physicians who are on-staff are able to access PACS.

Physician Orders

Fax: 678-312-9736

  • Valid physician orders are required prior to process patients.
  • Valid order criteria include: legible writing, patient name, procedure, clinical indications and physician’s signature (not extenders).
  • Unacceptable terminology includes: “possible,” “probable,” “suspected,” “rule out (R/O),” “questionable” or the use of arrows.
  • If the order was not faxed, the patient will be asked for the physician’s order at the time of check-in.
  • In the absence of a valid order, the ordering physician’s office will be contacted during the registration process.
  • Physicians' offices are encouraged to fax all orders to ensure the order is available at the time of service.

First-time Referring Physicians

The following information is required for first-time referring physicians:

  • Physician’s full legal name
  • Office address, phone number and fax number
  • Specialty
  • Georgia license number
  • UPIN

Forms for download:

If you have any questions, please call 678-312-3444.