(414) 266-2000

Urgent Care & ER

EMS request for information

This form is for Emergency Medical Services (EMS) personal to submit information about pediatric patients they deliver to Children's Hospital of Wisconsin's Emergency Department/Trauma Center. Our policy allows for two requests per patient by EMS.

Fill in the following information:

Requestor's Information
Patient's Information

Note: Please make sure run sheet is available. Fax run sheet to Children's Hospital of Wisconsin's Emergency Room/Trauma Center (ER/TC) at (414) 266-2496.

If information is needed for Critical Incident Stress Management (CISM) within 48 hours, please call Children's Hospital of Wisconsin's Transport Office at (414) 266-2470.

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Physician referral and consultation

(414) 266-2460

Toll free: (800) 266-0366
  • Refer a patient
  • Discuss a case
  • Arrange a direct admission
  • Arrange a transport
  • Staffed 24 hours a day for urgent and nonurgent needs

Referring Provider App


CHW Refer - The Pocket Directory on your phone

CHW Refer puts all the information you are used to finding in our popular Pocket Directory on your phone. Find our specialists by searching by name or specialty. Learn more.

Schedule an appointment for patients

Central Scheduling - Outpatient
Specialty Appointments
Monday - Thursday 7:30 a.m. - 7 p.m.
Friday 7:30 a.m. - 5:30 p.m.
(414) 607-5280

Request an Appointment