Tc99m HDP Order form

Equine Bone Scintigraphy Agent

Name

First Name

Last Name

Contact Number

Referring Veterinarian

The referring Veterinarian who has prescribed the required dose

First Name

Last Name

Delivery Day

Date (DD/MM/YYYY)

Injection Time

Dose (GBq)

Required dose at time of injection

Tracer Pty Ltd leases facilities from:

Queensland X-Ray Nuclear Medicine and PET CT Centre

Lower Ground Level, Administration Building Greenslopes Private Hospital

Newdegate Street GREENSLOPES QLD 4120

Contact Name: John Barlow

Mobile: 0409-867-851