3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ...OHSU South Waterfront Dental Clinic. 2730 S. Moody Avenue. Portland, OR 97201. Main Line: (503) 418-4334. After Hours Emergency Line: (503) 494-8311. Pediatric Dentistry is on the 11th Floor of Skourtes Tower. Maps and directions. OHSU Pediatric Special Needs Clinic, Doernbecher Children's Hospital. 700 SW.OHSU SOD Board-certified Oral and Maxillofacial Radiologists also provide comprehensive written radiographic interpretation reports for images taken at the referring doctor’s office. The images must be transferred via our HIPAA compliant system, as …Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Detailed reason for referral & what is being requested to evaluate. Last 3 months of chart notes. CT/MRI/PT/xray or ultrasound imaging results. 3. Fax the referral and all records to 503-346-6854.Fax the referral and all records to 503-346-6854. For help or to arrange provider-to-provider advice, call 503-494-4567. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being ...Five sources for finding job candidates include advertisements, internal referrals, job fairs, social networking and recruiting firms or databases. Employers have several options w...Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.Jan 8, 2020 · Annually it receives more than 30,000 inpatients and carries out more than 10,000 operations. Address: 1 Donggang West Rd, Chengguan district, Lanzhou, Gansu …Feb 16, 2023 ... It is your responsibility to ensure that the manager's referral form is fully completed and sent to relevant personnel; The form has a pre ...Email: [email protected] We are available from 8 a.m. to 6 p.m. Monday - Friday and urgent pager is covered 9 a.m. to 6 p.m. -- 7 days a week . For urgent matters requiring immediate assistance that occur outside of these hours, please contact 911, the Multnomah Crisis Hotline, or go to the nearest emergency room.Feb 15, 2022 · OHSU Strategic Communications 3181 S.W. Sam Jackson Park road Mail Code: L217 Portland, Or 97239-3098 Phone: 503 494-8231 Fax: 503 494-8246 …TEL 503-494-4567 TOLL FREE 800-245-6478 Please indicate the specialty to which you are referring your patient: Allergy and Immunology Arthritis and Rheumatology Bariatric SurgeryReferrals. If you are a referring provider, please fill out the New Patient Referral Form and fax it to 503-346-6854. If you are referring for Electroconvulsive Therapy (ECT), please fill out the Electroconvulsive Therapy Referral Form (ECT) and fax it to 503-346-6854. If you have questions about general psychiatry, please call 503-494-6176 to speak to our New …LIVER TRANSPLANT REFERRAL FORM . Fax Complete Referral to the Liver Transplant Program at: 503-494-5292. If your patient is scheduled for a liver transplant evaluation at OHSU, our program will do a thorough medical and psycho/social evaluation and make further recommendations. Patients who are felt to have substance abuse issues are HCM 21711599 12/01 OHSU Please check any of the following that apply to this patient being referred: 0 Does not want a transplant referral 0 Has active cancer 0 Is a resident of a long term care facility or is in hospice 0 Other (explain below) Title: HCM-21711599-Transplant-Referral-Form-vFNL.pdf Author: seberst Created Date: 4/26/2021 2:40:33 ...Check or update your mailing address: Go to one.oregon.gov and click on Manage Account. Call the Oregon Health Authority’s Customer Service Center at 800-699-9075 weekdays between 7 a.m.-6 p.m. Interpreters are available. Call OHSU Health Services Customer Service at 844-827-6572 (for TTY users, 711) weekdays between 7:30 a.m.-5:30 p.m.Email, fax, or mail this form , with the patient's chart notes and pathology report. Email: [email protected]; Fax: 503-494-0596; Mail: OHSU Department of Dermatology Dermatopathology – CH5D 3303 SW Bond Ave Portland, OR 97239; If you would like to check on available dates or schedule the appointment for your patient, call 503-494-6483 (voice). OHSU has the region's most comprehensive sports medicine program, which means our team of specialists takes care of all of your active lifestyle needs, from injury prevention to surgical and non-surgical treatment to rehabilitation. You don't need a referral to see an OHSU Sports Medicine specialist. Call for an appointment today: 503-494-4000 Female Urology Questionnaire (6) Female Urology Questionnaire (7) New Patient Form (M) New Patient Form (Hedges) Percutaneous Nephrolithotomy. Questionnaire for Dr. Amling Patients. Shock Wave Lithotripsy Prior to Surgery. Ureteroscopic Lithotripsy. Vasectomy Information (Hedges)We will partner with you to care for your patients with high-risk pregnancies. Call 503-494-4567 to seek provider-to-provider advice.; Fill out and fax the OHSU Perinatology referral form.; Our national experts are available for:3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ...Any missing information will delay treatment for your patient. 2730 S Moody Ave. Portland, OR 97201‐5042 Main Phone 503‐494‐8867. Referrals Phone 503‐346‐4791 FAX 503‐346‐8232 EMAIL [email protected]. Please provide pertinent medical records and images. Send all current, diagnostic images available: 3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral.OHSU South Waterfront Dental Clinic. 2730 S. Moody Avenue. Portland, OR 97201. Main Line: (503) 418-4334. After Hours Emergency Line: (503) 494-8311. Pediatric Dentistry is on the 11th Floor of Skourtes Tower. Maps and directions. OHSU Pediatric Special Needs Clinic, Doernbecher Children's Hospital. 700 SW.The COVID-19 vaccine available in fall 2023 is an updated vaccine, not a booster. It targets the current form of COVID-19, which changes over time. OHSU recommends that everyone age 6 months and older get the updated vaccine to protect against serious illness. Ages 5 and older: One shot is enough to fully vaccinate most people 5 and older, even ...Learn how to refer a patient to Doernbecher Children's Hospital, a leading pediatric care provider in Oregon. Find the relevant patient referral checklist, fax or e-referral forms, and other resources for health care professionals. Forms and Requisitions Downtime Requisitions-OHSU Use Only. Laboratory Requisitions Non-OHSU Submitter. Oregon Health & Science University is dedicated to improving the health and quality of life for all Oregonians through excellence, innovation and leadership in health care, education and research. ... OHSU is an equal opportunity affirmative ...TEL 503-494-4567 OHSU Referral Form 800-245-6478. Health (7 days ago) WebOHSU Referral Form Thank you for your referral. Please fax the following documents along with this form: PERTINENT MEDICAL RECORDS DEMOGRAPHIC SHEET …1. Create the OHSU Referral For GPR at the hospital: Open the OHSU adult referral form. Click on Other at the bottom left and add: Hospital Dental Services or Adult Dentistry. For OMFS in the hospital: Open the OHSU adult referral form. Click on Oral and Maxillofacial Surgery. For Doernbechers' (DCH): Open the OHSU pediatric referral form.Pediatric Patient Referral Checklist. Thank you for referring your patient to OHSU Doernbecher Children’s Hospital. The following checklist is designed to streamline referrals to our various specialty programs and clinics. If your patient needs to be seen in less than 48 hours, please call 503-346-0644 or 888-346-0644. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Abnormal SLUMS, MOCA, or MMSE within last 6 months. Push all Brain imaging to OHSU PACS and include report. 3. Fax the referral and all records to 503-346-6854.OHSU SOD Board-certified Oral and Maxillofacial Radiologists also provide comprehensive written radiographic interpretation reports for images taken at the referring doctor’s office. The images must be transferred via our HIPAA compliant system, as …1. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Records from all providers previously treating Dx. 3. Fax the referral and all records to 503-346-6854.Pediatric Imaging. X-ray, fluoro, ultrasound call 503-418-5252. CT, MRI, vascular call 503-418-0990. Pediatric Imaging. Fax orders to (503) 418-5253. Please be sure your doctor's office has sent an order to our office before scheduling with us. If your doctor requested that you get an X-ray before your appointment, it does not need to be ... Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ...TEL 503-346-0644 TOLL FREE 888-346-0644 Please indicate the specialty to which you are referring your patient: Adolescent Health / Eating Disorders Aerodigestive Clinic Allergy and ImmunologyOutpatient Order Form · Nutritional Services · Occupational Medicine · Useful ... OHSU Health's patient radiation shielding policy has changed. Learn more ...Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.Provided you use your own referral form, items should include: Patient name, date of birth, sex, meet and phone number; Referring provider’s name, address and phone piece; …3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ... Building or breaking a new habit in 21 days is a myth. But recent research suggests that it can take about 59 to 70 days for someone to form a new habit. How long does it take to f...OHSU Knight Cancer Institute. Driven to cure cancer. Devoted to caring for you. Our doctors and scientists are pioneers in targeted therapy and early detection. We give you complete care on the leading edge of discovery. Adrenal Cancer. Amyloidosis. Anal cancer. Appendix cancer.Oncology. Fax the referral form and clinical documentation to 614-293-9449. If urgent, call The James Line at 1-800-293-5066 to expedite. Please fill out this form completely, include any relevant clinical documentation, and fax all documents to 614-293-1456. Missing information may result in a processing delay. Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.A German court that’s considering Facebook’s appeal against a pioneering pro-privacy order by the country’s competition authority to stop combining user data without consent has sa...Physical therapy can help you: Manage pain, reducing the need for medication. Avoid, prepare for and recover from surgery. Improve range of motion, strength, flexibility and endurance. Improve balance and reduce the risk of falls. Recover from injury, stroke and paralysis. Return to optimal sports form. Make a referral . 800-245-6478. 800-245-6478. Spine care team. Our specialists treat the full range of conditions and injuries affecting the spine. Your care team will make a plan tailored to meet your specific needs. Meet the spine team Background image: Jung Yoo discusses treatment options with an OHSU Spine Center patient.Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.When an employer hires a worker, the law requires that taxes be withheld from the employee’s paycheck. To properly calculate the amount to withhold, the employer must use the worke...Jan 8, 2020 · Annually it receives more than 30,000 inpatients and carries out more than 10,000 operations. Address: 1 Donggang West Rd, Chengguan district, Lanzhou, Gansu …Sep 6, 2022 · OHSU Incoming Referral Center Please review the enclosed instructions to refer your patient to OHSU's Child Development and Rehabilitation Center (CDRC) page …OHSU Dental Clinics Patient Referral Information 2730 S Moody Ave. Portland, OR 97201-5042 Main Phone 503-494-8867 Referrals Phone 503-346-4791 FAX 503-346-8232 EMAIL [email protected] . Please fill out all fields. Any missing information can delay the referral process. Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Previous Neurology records. Push all Brain, Neck and Spine imaging to OHSU PACS and include report. Labs: Spinal tap, VEP, Vit D. 3. …Dec 6, 2019 ... Apply broadly, interview, talk to fellows, see things for yourself, form your own opinion. Take SDN reviews with a grain of salt. There's no ...HCM 21711599 12/01 OHSU Please check any of the following that apply to this patient being referred: 0 Does not want a transplant referral 0 Has active cancer 0 Is a resident of a long term care facility or is in hospice 0 Other (explain below) Title: HCM-21711599-Transplant-Referral-Form-vFNL.pdf Author: seberst Created Date: 4/26/2021 2:40:33 ...3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ...3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ...Any missing information will delay treatment for your patient. 2730 S Moody Ave. Portland, OR 97201‐5042 Main Phone 503‐494‐8867. Referrals Phone 503‐346‐4791 FAX 503‐346‐8232 EMAIL [email protected]. Please provide pertinent medical records and images. Send all current, diagnostic images available: 1. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: See Fibrotic Lung Disease. 3. Fax the referral and all records to 503-346-6854.Tel: 503-494-7246 Fax: 503-346-6961. Once we receive the referral, we will complete a medical review, benefi t check, and will call the patient to schedule if the referral is appropriate for our clinic. Please fax the completed referral form and documentation to 503-346-6961. If there are questions, please contact us at.Link to OHSU Home Referral Service. Show search input Menu. Search all of OHSU. Enter keyword Search; Step-by-Step Referral Instructions ... Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: No records required; 3. Fax the referral and all records to 503-346-6854.How to fill out the OSU letterhead (three-color) — OSU form on the web: To begin the blank, utilize the Fill camp; Sign Online button or tick the preview image of the blank. The …Please complete our Request for Transgender Health Services referral form and fax with relevant medical records to 503-346-6854. Learn more on our For Health Care Professionals page. Use this contact form if you are seeking services for yourself from the Transgender Health Program at OHSU. Mohs Micrographic Surgery Patient Referral Form . Oregon Health & Science University. Department of Dermatology Dermatologic Surgery . T: 503 494-6483 F: 503 346-8103 E: ... You may also email our office directly at [email protected] to attach photographs. Patient phone #: _____ Referring provider: _____ ...Physical therapy can help you: Manage pain, reducing the need for medication. Avoid, prepare for and recover from surgery. Improve range of motion, strength, flexibility and endurance. Improve balance and reduce the risk of falls. Recover from injury, stroke and paralysis. Return to optimal sports form. Consultation Request Form. The purpose of this form is to assist the provider with knowing whether this visit is to be billed as a consultation, new patient visit or established patient visit. Patient Preliminary Diagnosis, Symptoms or Signs: [This section should also be used to list any tests or procedures performed for this patient presenting ...Appointment information. To become a patient, please ask your doctor for a referral. For more information call us. 503-418-9888. 503-418-9888 CaCoon Program Referral Form ... Oregon Center for Children and Youth with Special Health Needs 503-494-8303 1-877-307-7070 [email protected] Our team, part of OHSU’s Child Development and Rehabilitation Center, offers: Oregon’s largest program with team care for complex developmental needs. A full evaluation that includes interviews, observation and tests to look for the causes of any issues. Specialists with experience diagnosing babies, children and teens.Fax the referral and all records to 503-494-4492. For questions, contact Clinic Transplant Services, Kidney Pancreas Transplant Program at 503-494-8500 or 800-452-1369, x8500. For pediatric kidney transplant : Fax the referral and all records to 503-346-6854. For help or to arrange provider-to-provider advice, call 503-494-4567. Provided you use your own referral form, items should include: Patient name, date of birth, sex, meet and phone number; Referring provider’s name, address and phone piece; …OHSU has the region's most comprehensive sports medicine program, which means our team of specialists takes care of all of your active lifestyle needs, from injury prevention to surgical and non-surgical treatment to rehabilitation. You don't need a referral to see an OHSU Sports Medicine specialist. Call for an appointment today: 503-494-4000.According to the IRS, its toll-free fraud hotline is 1-800-829-0433.Anybody who suspects or knows that a business or individual is in violation of the tax law can order a form #394...Tel: 503-494-7246 Fax: 503-346-6961. Once we receive the referral, we will complete a medical review, benefi t check, and will call the patient to schedule if the referral is appropriate for our clinic. Please fax the completed referral form and documentation to 503-346-6961. If there are questions, please contact us at.Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Previous Neurology records. Push all Brain, Neck and Spine imaging to OHSU PACS and include report. Labs: Spinal tap, VEP, Vit D. 3. …Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Recent chart notes. Push all Brain, Neck and Spine imaging to OHSU PACS and include report. Genetic testing if available. 3. Fax the referral and all …If you need to reach a specific OHSU clinic to check on your referral, for example, or because you’re running late for your appointment, please call the clinic directly. If you don’t see the number you need below, call OHSU’s main number: 503-494-8311. Please see our team page to find providers. HCM 21711599 12/01 OHSU Please check any of the following that apply to this patient being referred: 0 Does not want a transplant referral 0 Has active cancer 0 Is a resident of a long term care facility or is in hospice 0 Other (explain below) Title: HCM-21711599-Transplant-Referral-Form-vFNL.pdf Author: seberst Created Date: 4/26/2021 2:40:33 ...Information on Referral Processing: Although you may have selected a specific clinic above, the Referrals Team will route the referral to the appropriate OHSU Dental Clinic to best serve the needs of the patient. If further information is necessary, we will contact you. Medicine Matters Sharing successes, challenges and daily happenings in the Department of Medicine Referral synonyms display when ordering specialty eConsults to Neurology, Vascular...You'll no longer be able to earn free rides or other bonuses for referring riders or drivers to Uber. Update: Some offers mentioned below are no longer available. View the current ...OHSU Doernbecher Fetal are Referral Thank you for your referral. Please fax the following documents along with this form: ALL PRENATAL RECORDS DEMOGRAPHIC SHEET FAX TO: 503-346-8215 Patient Information Patient name: Street Address: ity, state: Zip ode: Date of …Information on Referral Processing: Although you may have selected a specific clinic above, the Referrals Team will route the referral to the appropriate OHSU Dental Clinic to best serve the needs of the patient. If further information is necessary, we will contact you. Add the Ohsu clinic referral form for editing. Click on the New Document option above, then drag and drop the document to the upload area, import it from the cloud, or using a link. Alter your template. Make any changes needed: add text and images to your Ohsu clinic referral form, highlight information that matters, erase sections of content ...What makes the ohsu adult referral form legally valid? Filling out a pile of reports continues to be a necessary evil in today's modern world, and ohsu clinic referral form get is not an exclusion. However, modern technologies have made this task a little bit simpler by empowering us to complete paperwork in electronic format. Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567.
The autism team at OHSU’s Child Development and Rehabilitation Center takes a whole-person approach to diagnosing your child and connecting your family with services in your community. Families from Oregon, Washington, Idaho and California travel to us for our: ... Fax our CDRC referral form to 503-346-6854; See our autism referral checklist .... Today's coldest temperature
OHSU SOD Board-certified Oral and Maxillofacial Radiologists also provide comprehensive written radiographic interpretation reports for images taken at the referring doctor’s office. The images must be transferred via our HIPAA compliant system, as …There's yet another huge welcome offer for the personal Amex Platinum Card for 150,000 points. This offer is showing up through referral links. Increased Offer! Hilton No Annual Fe...Jun 7, 2021 · Mohs Micrographic Surgery Patient Referral Form . Oregon Health & Science University ... T: 503 494-6483 . F: 503 494-0596 . E: [email protected] . Mail code: CH5D ... 1. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: No records required. 3. Fax the referral and all records to 503-346-6854.OHSU SOD Board-certified Oral and Maxillofacial Radiologists also provide comprehensive written radiographic interpretation reports for images taken at the referring doctor’s office. The images must be transferred via our HIPAA compliant system, as …CDRC new patient referral form . For a patient to be seen at the Child Development and Rehabilitation Center clinics, this referral form must be completed by a medical professional. We do not provide services for or accept referrals for: – Mental health/psychiatric evaluation without developmental concerns Medical Eye Exam. 1. Start the referral process: Use your own referral form or notes* or download one of our forms: 2. Gather records: 3. Fax the referral and all records to 503-346-6854.Consultation Request Form. The purpose of this form is to assist the provider with knowing whether this visit is to be billed as a consultation, new patient visit or established patient visit. Patient Preliminary Diagnosis, Symptoms or Signs: [This section should also be used to list any tests or procedures performed for this patient presenting ...Crunches are the classic ab exercise (although planks and push-ups have their fans too). To really target your abs, though, it’s important to use good form. Crunches are the classi...To fill out the OHSU Clinic Referral Form, follow these steps: 01 Obtain the form: You can request the referral form from OHSU Clinic by contacting their office or visiting their …Point-of-service, health maintenance organization, and preferred provider organization are the three common group health insurance structures in the United States. POS insurance bl...1. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Must have an order from a provider. 3. Fax the referral and all records to 503-346-6854.Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Neurologist records if Previously Seen. Push all brain imaging and reports to OHSU PACS and include report. 3. Fax the referral and all records to 503-346-6854.19260 S.W. 65th Ave., Suite 435. Tualatin, OR 97062. 971-262-9700. Fax: 971-262-9701. Hours: 8 a.m. to 5 p.m. weekdays. Map and directions. The OHSU Knight Cancer Institute offers infusion services throughout the Portland area for your patients with cancer or blood diseases. Follow our simple steps to order infusion therapy and allow your ...Fibromyalgia. Department. Comprehensive Pain Center; Rheumatology. 1. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 3. Fax the referral and all records to 503-346-6854.Become a member of the Psych Central medical network! Allow clients to find you with unique custom filters, including: Psych Central’s comprehensive medical integrity team will vet...Patient name, date of birth, sex, address and phone number. Referring provider’s name, address and phone number. Diagnosis or reason for referral. Department patient is being referred to. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567. TEL 503-494-4567 TOLL FREE 800-245-6478 Please indicate the specialty to which you are referring your patient: Allergy and Immunology Arthritis and Rheumatology Bariatric SurgeryGenetic Counseling. 1. Start the referral process: 2. Gather records: 3. Fax the referral and all records to 503-346-6854. Most recent chart notes supporting the diagnosis or reason for referral. For help or to arrange provider-to-provider advice, call 503-494-4567. 3. Fax the referral and all records to 503-346-6854. * Referral notes or forms should include: Patient name, date of birth, sex, address and phone number; Referring provider’s name, address and phone number; Diagnosis or reason for referral; Department patient is being referred to; Most recent chart notes supporting the diagnosis or reason ...Referral information (if insurance requires referral: approval number and date span); Diagnoses; Relevant chart notes. Advance Directive Form. As long as you ....