CBCT Referral

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Referring Practice

CBCT Practice

Name: Combe Road Denta
Address: 6 Combe Road
Portishead
Bristol
BS20 6B
Tel: 01275 817781
Email: manager@comberoaddental.co.uk
Name of Legal Person: Dr. Sarah Najjar
GDC No: 267689

Referral Criteria for Dental CBCT

The document specified here will be used by both parties as the basis for the referral of patients and the justification/
authorisation of dental OPG & CBCT examinations:

Entitlement of People

Evidence of training meeting the requirements of the PHE/BSDMFR Core Curriculum in Dental CBCT must be provided.

Report Requested
CBCT Requirements and Justification by Referrer

Signature of Agreement

We, the undersigned agree: (1) to use the referral criteria above (2) that evidence of adequate training has been provided for each of the people named above appropriate to their IRMER17 roles (3) that adequate information will accompany each referred patient to allow the justification process to proceed, as set out in the standard imaging referral form attached. Combe Road Dental is not responsible for the content, accuracy, interpretation, or any other aspect of this CBCT report. If a report has been requested, it will be outsourced to a third company party and all questions regarding its contents should be directed to them.

For the Referring Practice

 

Clear Signature
Date / Time

* The ‘Legal Person’ is the person/body corporate that takes legal responsibility for implementing the Ionising
Radiation Regulations 2017 and the Ionising Radiation (Medical Exposure) Regulations 2017 within the practice.

Opening Hours

Please note we are closed for lunch between 1:00 pm – 2:00 pm Monday-Friday.
Copyright © Combe Road Dental 2024. All rights reserved.
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