Image Transfer Request

Our state-of-the-art Image Transfer platform allows registered users fast access to both current and past reports and images. Please complete the form below for quick transfers of patient reports and images.

Hospitals – Fuji SYNAPSE Mix

For the transfer of patient images from Lake Imaging directly to your hospital PACS, please use the Fuji SYNPASE Mix system. Your radiology department can assist you with this process or you can complete and submit the form below. Should you require IT support, please call our dedicated RIS/PACS Support Staff on 1300 071 381 or riscaptain@lakeimaging.com.au

Requested By*
First Name Last Name
Department
Date Requested
Date Required
Email*
For Review By
Image Transfer
Original imaging sent from:
Imaging sent to:
Patient Details
Patient Name*
Frist Name Last Name
Date of Birth*
Day
Month
Year
Hospital
Patient ID / MRN
Study Details
Procedure*
Date
Accession Number
*
- Tick if you require raw DICOM data
- Send me an email confirmation of the above request
For further assistance, please refer to IT Support
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