X-Ray Requisition Chart

Situations when a registered nurse may complete an x-ray requisition

RN(EC) ordering an x-ray

RN implementing a medical directive

Class of Registration

A member of the College of Nurses of Ontario who is a registered nurse with an Extended Class (EC) certificate of registration-RN(EC)

Any member of the College of Nurses of Ontario who is a registered nurse in the General Class or the Extended Class

Type of X-Ray

May order any of the following x-rays:

•	Chest and ribs
•	hand, wrist, arm up to and including the head of the humerus but not the shoulder
•	foot, ankle, leg up to and including the head of the femur, but not the hip
•	mammography

An x-ray identified in a medical directive that had been developed in accordance with the joint policy regarding medical directives for x-rays approved by the CMRTO, CNO and CPSO (1995) and supported by the Ministry of Health.

Circumstances

The RN(EC) has assessed the client and determined the need for one of the specified x-rays included above.

Radiographic findings based on the report from the radiologist will be incorporated into the client’s plan of care.

The RN assesses the client and determines whether the specified circumstances and specific conditions include in the medical directive have been met.

A medical directive includes the following:

•		a description of the x-ray procedure to be performed
•		specific clinical criteria and client must be met
•		any circumstances which must exist
•		the name and signature of the phyician responsible for the directive
•		the date and signature of the administrative authority approving the directive

Setting

In the RN(EC)s primary health setting

In any setting

Authority

Section 6 of the HARP Act (as a result of the ENSP Act) has been amended to authorize RN(EC)s to order specific x-rays. The nurse will complete the requisition and include the identifier RN(EC) with his/her signature to confirm his/her legal authority to order the x-ray.

The medical directive is the actual “order” from the physician. The RN is responsible for assessing the client and implementing the medical directive. The RN will complete the requisition and include his or her signature, the name of the physician responsible for the care of the client and reference to the specific medical directive.

Note: Any other x-ray which does not fall within the above situation must be ordered by a physician (or any other person authorized under Section 6 of the HARP Act) by means of a client specific order

This chart outlines situations when a RN may complete an x-ray requisition. It provides a brief summary of the circumstances and conditions which must be present in order that an MRT has the necessary authority to administer ionizing radiation to a patient/client in accordance with Section 6 of the HARP Act. Reference may be made to the CMRTO policy on Medical Directives for X-Rays (CMRTO, 1995), When, Why and How to Use Medical Directives (CNO, 1995), or the Standards of Practice for Registered Nurses in the Extended Class – Standards for Ordering X-Rays and Ultrasounds (CNO, 1998) to ensure consistency with the relevant legislation, regulations or policy.