Referring Provicers
At Capitol Imaging Services (CIS), we are dedicated to providing referring providers with state-of-the-art technology, professional expertise, and patient-centered care. To streamline the referral process, we offer a series of links and forms designed to help you quickly and efficiently refer patients, submit order forms, request service referral pads, and access key information about each facility’s equipment and capabilities. You will also find guidelines for exam criteria, titles, codes, and recommended wording to ensure accuracy in ordering.
Fillable Referral Order Forms
The Capitol Imaging Services Fillable Referral Order Form is used in place of the traditional paper order form. Many of our referral partners prefer to fill out this editable PDF and safe it directly to their EMR system. This document may also be attached to the electronic referral order form below.
Fillable Referral Order Forms
Submit Referral Order
The Submit Referral Order Form is an electronic referral order form to be sent to the CIS location of your choice. You may also attach the above Fillable Referral Order Form to this form as well.
Submit Referral Order
Services Order Pads
Service Order Pads are used by referring providers to order imaging exams. Providers can request referral pads by clicking the button below, and a Sales Specialist will deliver them directly to your office.
Service Order Pads
Referrer Info Packet
The Referrer Information Packet provides details on each CIS location's available imaging equipment and exam capabilities. Additionally, details on imaging exam locations and self-pay pricing for out-of-pocket patients are available.
Referrer Info Packet
Locations &
Technology
The Locations & Technology guide below provides a list of all CIS locations, their phone/fax numbers, and the imaging equipment at each location.
View Affiliates
Radiology Ordering Guide
The Radiology Ordering Guide provides essential information for imaging exams, including clinical signs, exam criteria, correct titles with ICD codes for billing, and suggested requisition wording.
Radiology Ordering Guide
ACR Imaging Appropriateness Criteria
The ACR Imaging Appropriateness Criteria form is a downloadable evidence-based guideline designed to assist referring physicians and other providers in making the most appropriate imaging or treatment decisions for specific clinical conditions.
ACR Imaging Appropriateness Criteria
