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Physician Call Center (Consults / Referrals /Transports) (414) 266-2460 (800) 266-0366 toll-free |
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Central Scheduling (Outpatient Specialty Appts.) (414) 607-5280 (877) 607-5280 toll-free |
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Specialty Clinic Referral Forms
Outpatient Order Forms and Consent Forms
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Outpatient Diagnostic/Rehab Services Orders - Includes Cardiology, Neuro-Diagnostic, Pulmonary Function, Rehabilitative Services, Anesthesia and Esophageal pH probe.
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Outpatient Laboratory Orders - Includes commonly ordered tests of blood, urine, and stool, in addition to common cultures and drug levels.
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Outpatient Specialty Laboratory Orders - Includes infrequently ordered specialty tests of blood and urine.
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Outpatient Radiology Orders - Includes General Radiology, Fluoroscopy, CT Scan, Nuclear Medicine, PET/CT, MRI/MRA Scans and Ultrasound.
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HIV Testing Documentation - Used to document verbal consent for HIV Testing.
In order to view the forms and consents, you must have version 4 or higher of Adobe Acrobat Reader installed on your computer.

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