Thank you for your referral. Below is an outline of steps in making
a referral to us.
1. Please complete Maternal-Fetal Consultation cover sheet and have the patient complete the OB Medical History form and fax/e-mail both with patient records when requesting an appointment.
2. Please fax/e-mail all patient records when you are scheduling the appointment. This ensures that your patient is scheduled in the appropriate clinic (FDC, MFM or High Risk), which is based on medical history. Be sure to include: patient OB history, original labs and all ultrasounds.
3. Give the patient a copy of each of these:
PATIENT CHECKLIST and MAP
CONTRACT WITH PATIENT
Ask her to complete these forms and bring them with her to her first appointment with us. If you prefer, you can send the completed forms directly to us by scanning and emailing forms to firstname.lastname@example.org.
4. Please advise your patient that if they are late for their appointment by 30 minutes they will be re-scheduled so we can be timely with all our patients.
Referring Physicians contact us at: (251) 415-1496.
To request ultrasounds, amnio or fetal heart tests call (251) 415-1496.
All preliminary high risk obstetrics, prenatal diagnosis (FDC), and ultrasound reports will be faxed to your office Monday-Friday. All final consult letters will follow in 10-14 days.
Phone calls are made on
critical cases to your nurse
or directly to the referring doctor.
© 2016 USA Health System