Referrals

Specialty Clinic Referral Forms

• Airway, Digestive and Voice Center Referral.
• Cardiac Cath Lab.
• Endocrine Clinic.
• Feeding, Swallowing and Nutrition Center.
• Motility and Functional Bowel Disorders.
  Note: For all other GI referrals call Central Scheduling at (877) 607-5280.
• Neurology Clinic.
• NEW (Nutrition, Exercise and Weight Management) Kids^TM Program.
• Psychiatry and Behavioral Medicine Center.
  Note: Due to special requirements for mental health referrals, the parent/guardian must contact the center at (414) 266-3339 once the referral has been faxed to complete the intake and scheduling process. You now have the option to obtain the parent/guardian signature (if the patient is age 14 or older) at the time of referral to authorize the Psychiatry Center to communicate with you about the referral. Call the Psychiatry Intake line at (414) 266-3339 with questions.
• Pulmonary Clinic.
• Sleep Center.

Outpatient Order Forms and Consent Forms

• Outpatient Diagnostic/Rehab Services Orders - Includes Cardiology, Neuro-Diagnostic, Pulmonary Function, Rehabilitative Services, Anesthesia and Esophageal pH probe.

• Outpatient Laboratory Orders - Includes commonly ordered tests of blood, urine, and stool, in addition to common cultures and drug levels.

• Outpatient Specialty Laboratory Orders - Includes infrequently ordered specialty tests of blood and urine.

• Outpatient Radiology Orders - Includes General Radiology, Fluoroscopy, CT Scan, Nuclear Medicine, PET/CT, MRI/MRA Scans and Ultrasound.

• HIV Testing Consent - Includes consent for HIV testing and disclosure of results.
  Note: If ordering the rapid HIV antibody screen you must give the patient/legal guardian the patient education sheet called "Rapid HIV Test." or "Spanish Rapid HIV Test."  Print the patient education sheet by clicking the link then the printer icon. The patient/legal guardian must be given this information prior to signing the consent form for the test.
  (English / Spanish)

• HIV Ongoing Monitoring Consent - Includes consent for HIV monitoring for a specified period of time and the disclosure of those results.
  (English / Spanish)

In order to view the forms and consents, you must have version 4 or higher of Adobe Acrobat Reader installed on your computer.