Ohsu referral form

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; …1. Start the referral process: Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Pathology/Scans. 3. Fax the referral and all records to 503-346-6854.Call for intake 503 494-6176. Location: Doernbecher Children's Hospital, 7th Floor under the Butterfly Parking: Doernbecher Children's Hospital Parking Clinic Hours: Monday through Friday, 8:30a.m. to 5 p.m. Fax: 503 494-6170. The Pediatric Neuropsychology Clinic provides comprehensive evaluations for children and adolescents with suspected ...Select your patient’s name. Go to the “Referrals” tab. Click on “Chart Review”. Open the referral. You should see activity so far, such as medical review of the referral or a message left for the patient. If you don’t see your referral or need help: Call 503-494-4567 and choose option 4.OHSU Casey Eye Institute is a premier academic medical center providing eye care for adults and children in the Pacific Northwest and beyond. We treat eye conditions from the most straightforward to the most complex, and offer expert care in all ophthalmology specialties. Learn more about our clinics and services . Contact us at 503-494-7970 or [email protected] with questions. Please complete our Request for Transgender Health Services referral form. Some services have specific prerequisites for patients to be seen. Please make sure all fields on the form are complete. Fax the referral form to 503-346-6854. 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 …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.For forms and guides in several languages, including appointment verification forms, visit this page. Contact information: Regular business hours: 8 a.m.-5 p.m., Monday through Friday, except holidays. Portland metro area: 503-416-3955 , [email protected]. Pharmacy formulary and guidelines.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 503-346-6854.1. 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 Casey Eye Institute is a premier academic medical center providing eye care for adults and children in the Pacific Northwest and beyond. We treat eye conditions from the most straightforward to the most complex, and offer expert care in all ophthalmology specialties. Learn more about our clinics and services . 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.Taxpayers have numerous options for accessing their Form W-2 online. Employers are typically the quickest route to retrieving this information, but employees can also contact their...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 Oral Surgery Dental Clinic at South Waterfront 2730 S. Moody Ave Portland, OR 97201 Floor 11 Access directions here. Main Line: (503) 346-4756 8:00am - 4:45pm | Monday - Friday. After Hours Emergency Line: (503) 494-8311. Email: mailto:[email protected]. OHSU Dental and Oral Surgery Clinic, Marquam Hill 3181 SW Sam Jackson Park Rd 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.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 …American Express is targeting some cardholders with an offer to earn up to 100,000 Membership Rewards points this year through referrals. Increased Offer! Hilton No Annual Fee 70K ...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 ... 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.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 …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...Outpatient Order Form · Nutritional Services · Occupational Medicine · Useful ... OHSU Health's patient radiation shielding policy has changed. Learn more ...A look at how new flexibility with the Chase Freedom cards make it even easier to earn referral bonuses when your friends sign up for new Chase credit cards TPG-Update: Some offers...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 …The General Practice Residency is a one-year program that introduces dentists to Adult Hospital practice. It facilitates optimal comprehensive oral and systemic health for patients in a dynamic contemporary clinical, educational, and scientific environment. The program emphasizes the treatment of patients with special needs, including those ... Lanzhou University Second Hospital has a complete installation of disciplines with special features. It accommodates 2,166 medical beds, 34 clinical medical treatment centers, …Want to know how to create a contact form in WordPress? Learn how to do so using a simple WordPress form plugin in this guide. Plus, other plugin options. Installing & Customizing ...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 ...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 ...Therefore, the signNow web app is essential for filling out and signing ohsu ohsu cdrc referral form on the run. In just a few seconds, receive an e- document with a fully legal …OHSU Dental Clinics Patient Referral Information 2730 SW 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. Date: _____ 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.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.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. 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. Referral/Authorization - Commercial only Behavioral Health Authorization Request Form OHSU Employee Massage Therapy Request Form eviCore Procedures and services …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. Call for intake 503 494-6176. Location: Doernbecher Children's Hospital, 7th Floor under the Butterfly Parking: Doernbecher Children's Hospital Parking Clinic Hours: Monday through Friday, 8:30a.m. to 5 p.m. Fax: 503 494-6170. The Pediatric Neuropsychology Clinic provides comprehensive evaluations for children and adolescents with suspected ...OHSU Perinatology 3181 S.W. Sam Jackson Park Road • Portland, OR 97239-3098 tel: 503 418-4200 • fax: 503 494-2759 Please include Patient Demographics sheet with records and have patient contact Registration at (503) 494-8505 to pre-register before scheduling appointments. Date: _____ Patient Information3. 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 ... Medicine Matters Sharing successes, challenges and daily happenings in the Department of Medicine Referral synonyms display when ordering specialty eConsults to Neurology, Vascular...WHO Collaborating Centre for Guideline Implementation and Knowledge Translation. Director / Head: Professor Kehu Yang. Yaolong Chen. [email protected]. …OHSU Dental Clinics Referral Form Updated 03/28/2019 OHSU DENTAL CLINICS AT THE SOUTH WATERFRONT . STUDENT DENTAL CLINIC . GRADUATE SPECIALTY CLINICS . Skourtes Tower, Robertson Life Sciences Building . 2730 SW Moody Ave. Portland, OR 97201-5042 . Main Phone 503-494-8867 . Referrals Phone 503-346-4791 FAX 503-346 …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). 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 ...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.Neuro-Ophthalmology. 1. Start the referral process: 2. Gather records: Last three chart notes, including why patient is being referred. MRI/CT/imaging of brain, neck, head, orbits, cervical spine, sinus, or chest (done within the last 3 years) 3. Fax the referral and all records to 503-346-6854.Want to know how to create a contact form in WordPress? Learn how to do so using a simple WordPress form plugin in this guide. Plus, other plugin options. Installing & Customizing ...Incfile offers free LLC formation, a registered agent, compliance, and startup services in one place. All for $0 plus the state fee to start. Filing costs for forming an LLC range ...OHSU Perinatology. 3181 S.W. Sam Jackson Park Road • Portland, OR 97239-3098 tel: 503-418-4200 • fax: 503-494-2759 . Please include patient demographics sheet with records and have patient contact registration (503-494-8505) to pre-register before scheduling appointments. Date: _____ Patient Information Authorizations for advanced imaging studies and musculoskeletal services are obtained through eviCore healthcare. Log in to eviCore's Provider Portal at. www.evicore.com. Phone: 844-303-8451. For more information and codes requiring authorization go to www.evicore.com. Specialty Infusion/Injectable Drugs. 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 Transplant Referral Form Patient information ... Concerns or special notes regarding this referral (non-compliance, drug use, tobacco use, psychosocial): 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 ...The General Practice Residency is a one-year program that introduces dentists to Adult Hospital practice. It facilitates optimal comprehensive oral and systemic health for patients in a dynamic contemporary clinical, educational, and scientific environment. The program emphasizes the treatment of patients with special needs, including those ... 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. copy of this form to the REFERRAL FORMS folder. *Should this be your first time, please call us at 503-494-8790 to set up your BOX drive. Report Fee: $ 85.00 Fee will be invoiced to the referring doctor. Payment instructions will be provided. OHSU will not bill patient directly for any reading. This is a service agreement between OHSU and ...Select your patient’s name. Go to the “Referrals” tab. Click on “Chart Review”. Open the referral. You should see activity so far, such as medical review of the referral or a message left for the patient. If you don’t see your referral or need help: Call 503-494-4567 and choose option 4.3. 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 ...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 …After we receive referral information, we will review clinical and insurance information and offer an intake appointment if appropriate. Please fax the completed referral form and documentation to (503) 494-6170 If there are any questions, contact us at (503) 494-6176 to reach our intake team. 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.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 ...The General Practice Residency is a one-year program that introduces dentists to Adult Hospital practice. It facilitates optimal comprehensive oral and systemic health for patients in a dynamic contemporary clinical, educational, and scientific environment. The program emphasizes the treatment of patients with special needs, including those ... Fax this form and all pertinent medical records to TH P at 503-346-6854 . Medical Information . Primary diagnosis code : Is patient taking hormones ... be selected to process referral Chest Surgery - Feminizing Chest Surgery - Masculinizing Facial Feminization Surgery Hair Removal (Electrolysis) Hair Removal (Laser) Gynecologic Care (Non ...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 ...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. Use your own referral form or notes* or download our form: Adult referral form. 2. Gather records: Previous Neurology records. Recent chart notes. Push all Brain imaging to OHSU PACS and include report. 3. Fax the referral and all records to 503-346-6854.Are you a business owner looking to expand your customer base and improve your credibility? Look no further than Tom Martino’s Referral List. In this comprehensive guide, we will e...1. Start the referral process: 2. Gather records: 3. Fax the referral and all records: 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. Fax the referral and all records to 503-346-6854.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 ... 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: _____ ...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. The OHSU (Oregon Health & Science University) clinic referral form is a document used to request a referral to a specific clinic or specialist at OHSU. It is typically completed by a primary care physician or another healthcare provider who believes that a patient's medical condition requires specialized care.Call for intake 503 494-6176. Location: Doernbecher Children's Hospital, 7th Floor under the Butterfly Parking: Doernbecher Children's Hospital Parking Clinic Hours: Monday through Friday, 8:30a.m. to 5 p.m. Fax: 503 494-6170. The Pediatric Neuropsychology Clinic provides comprehensive evaluations for children and adolescents with suspected ...Neuro-Ophthalmology. 1. Start the referral process: 2. Gather records: Last three chart notes, including why patient is being referred. MRI/CT/imaging of brain, neck, head, orbits, cervical spine, sinus, or chest (done within the last 3 years) 3. Fax the referral and all records to 503-346-6854.1. Start the referral process: 2. Gather records: 3. Fax the referral and all records: 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. Fax the referral and all records to 503-346-6854.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. 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.Impotence of Organic Origin. 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.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 ImmunologyFor forms and guides in several languages, including appointment verification forms, visit this page. Contact information: Regular business hours: 8 a.m.-5 p.m., Monday through Friday, except holidays. Portland metro area: 503-416-3955 , [email protected]. Pharmacy formulary and guidelines.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 ... 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 ...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: CDRC new patient referral form. 2. Gather records: Detailed chart notes documenting concern. 3. Fax the referral and all records to 503-346-6854. 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.Please fax the completed referral form and documentation to 503 418-5774. If there are any questions please contact 503 494-6176 and ask for the new patient coordinator. School of Medicine Department of Psychiatry Mail code OP-02 3181 S.W. Sam Jackson Park Road Portland, OR 97239-3098 tel 503 494-6176 fax 503 418-5774 www.ohsu.edu Download the Referral Form (PDF).; Fill out and fax the referral form and clinical documentation to: For referrals to The Ohio State University Wexner Medical Center, fax to 614-293-1456.; For referrals to the James Cancer Hospital and Solove Research Institute, fax to 614-293-9449.; After we have received your fax, we will contact your patient …Make an appointment. Call 503 494-6400. Schedule an appointment. Ask a question. Seek a second opinion.More questions? Contact our Patient Specialists for additional information. Main Line: (503) 494-8867 | para Español, presione 8 After Hours Emergency Line: (503) 494-8311 Fax: 503-346-8232 Email: [email protected] Open Monday - Friday 8:00 a.m. to 4:45 p.m.Diagnostic Radiology Imaging Order Form for most studies_032521.docx OHSU flame logo in white 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.WHO Collaborating Centre for Guideline Implementation and Knowledge Translation. Director / Head: Professor Kehu Yang. Yaolong Chen. [email protected]. …Nov 16, 2021 · If your referral was not accepted by Hospital Dental Services, the referral still must be sent to our location to be processed. Referrals sent to Hospital Dental Services …OHSU Perinatology 3181 S.W. Sam Jackson Park Road • Portland, OR 97239-3098 tel: 503 418-4200 • fax: 503 494-2759 Please include Patient Demographics sheet with records and have patient contact Registration at (503) 494-8505 to pre-register before scheduling appointments. Date: _____ Patient Information1. Start the referral process: For referrals to Child Development and Rehabilitation Center, use your own referral form or notes* or download our form:. CDRC new patient referral form. For referrals to Otolaryngology and Head and Neck Surgery, use your own referral form or notes* or download one of our forms:. Adult referral formPh: 503-494-4248 Fax: 503-494-8486 Email: [email protected] for office use only ENDODONTIC REFERRAL FORM Please EMAIL to [email protected] or FAX to 503-494-8486 or MAIL to SD ENDO 2730 SW Moody Ave, Portland OR 97201. Thank you. Date: PATIENT INFORMATION Last Name First MI Home Telephone Other Telephone 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 ...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 Referral Form Please provide the following so we can schedule an appointment: PERTINENT MEDICAL RECORDS DEMOGRAPHIC SHEET INSURANCE …1. Start the referral process: For referrals to Child Development and Rehabilitation Center, use your own referral form or notes* or download our form:. CDRC new patient referral form. For referrals to Otolaryngology and Head and Neck Surgery, use your own referral form or notes* or download one of our forms:. Adult referral formThe 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 ...Authorizations for advanced imaging studies and musculoskeletal services are obtained through eviCore healthcare. Log in to eviCore's Provider Portal at. www.evicore.com. Phone: 844-303-8451. For more information and codes requiring authorization go to www.evicore.com. Specialty Infusion/Injectable Drugs.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. | Cwdpnfl (article) | Msnwynm.