How To Refer a Patient Department Directory >
- Download the appropriate Patient Referral Form below.
- Fax the completed referral form to: 510-995-2955 or 510-995-2956
Patient Referral Forms (PDF)
- Standard Patient Referral Form (See exceptions below: Clinic Referral Forms)
- Specialty Care Outpatient Clinic Appointments:
- Please check Preferred Location box at the top of the Standard Referral Form.
- Subspecialty Clinic Schedules
- Please check Preferred Location box at the top of the Standard Referral Form.
- Specialty Care Outpatient Clinic Appointments:
- Emergency Department Referral Form
- Diagnostic Imaging Referral & Order Form
- Pulmonary Function Test Request Form
- Mental Health & Child Development Referral Form - Include the following:
- Insurance Card: Include a fax copy (front and back).
- Authorization: If insurance authorization is required for mental health services, the referring provider/primary care physician is required to obtain the initial authorization in order for us to schedule the appointment.
- Review Period: Allow a 2-week review process before calling to schedule an appointment.
- Medical Records: Fax all relevant medical records.
- Complete the entire referral form to avoid any further delays.
- Questions? Please contact us at 510-824-8428.
New Patient Referrals
Please include the following 6 items:
- Physician Name, Office Address, Phone and Fax Number
- Patient Name, Date of Birth and Parent or Guardian's Name
- Reason for Referral
- Clinic Name (see below for full list) or Physician Name you are referring to
- Insurance Information for Patient
- Authorization (when required)
Fax Referral Management Process
- When received, your fax is stored on a secure server as a PDF.
- A fax-confirmation reply is sent thanking you for the referral.
- The fax-confirmation includes:
- Patient name
- Date of birth
- Department referred to
- Date and time we received your fax
- Your referral is then routed to the appropriate department for processing.
Patient Referral FAQs
What if I need to send notes or an authorization later?
- Children’s requires the patient information below to relate the new documents to the original referral.
Be sure the following information is printed legibly on the authorization or medical notes:
- Patient Name
- Birth Date
- Referral Department Name
- Fax completed forms to: 510-995-2955 or 510-995-2956
- We will reply with a confirmation fax.
Should urgent referrals be sent to the fax line?
No. For urgent referrals, please call the specialty department directly and have the referring physician speak to the specialist on call. Specialties such as Cardiology and Hematology/Oncology use these consults to determine how soon a patient needs to be seen.
Who makes the appointment?
While some Children’s departments contact the family to schedule an appointment, your patient’s family should call the specialty department directly. Processing the fax referral will take up to one day. Ask the family to wait one business day from referral-receipt before calling.
Who do I call with questions?
Questions about the referral management system should be directed to your physician liaison. Call Physician Liaison Services at: 510-428-3043
If you wish to confirm that a specialty department received your referral, please call:
1-800-400-7337
How do I register as a referring office?
Your physician liaison will ask for a list of the physicians and NPs that refer patients from your office, along with your office fax number, and then assign you a referral fax number. If you don’t know who your liaison is, please call Physician Liaison Services at: 510-428-3043
Do you have a Patient Appointment Information Card I can offer to my patients?
Download an Appointment Information Card to give all the referral information to your patient.
| 2010 Referral Directory (print version available) Call: 510-428-3043 |
Physician Helpline: Quality Department Email: PhysicianHelpline@mail.cho.org Phone: 510-428-3828 |
||
DEPARTMENT |
PHONE |
CONTACT |
|
Adolescent Medicine |
(510) 428-3885 ext. 2742 |
Barbara Staggers. MD |
|
Anesthesiology |
(510) 428-3070 |
Richard Rowe, MD |
|
Audiology |
(510) 428-3344 |
|
|
Blood and Marrow |
(510) 428-3374 |
Mark Walters, MD |
|
Cardiology |
(510) 428-3380 |
Hitendra Patel, MD |
|
Cardiothoracic Surgery |
(510) 428-3294 |
Olaf Reinhartz, MD |
|
Center For Child Protection |
(510) 428-3759 |
James Crawford, MD |
|
Center For the Vulnerable Child |
(510) 428-3148 |
Diana Kronstadt, EdD |
|
Clinical Nutrition |
(510) 428-3885 ext.2008 |
Karen Amorde-Spalding MS,RD, CSP |
|
Cord Blood Program |
(510) 428-3374 |
Mark Walters, MD |
|
Cranofacial Center |
(510) 428-3885 ext. 4891 |
Bryant Toth, MD, |
|
Critical Care Services/ |
(510) 428-3719 |
Sharon Williams, MD |
|
Day Hospital |
(510) 428-3372 |
James Feusner, MD |
|
Developmental and |
(510) 428-3385 ext. 5126 |
Lane Tanner, MD |
|
Diagnostic Imaging |
(510) 428-3885 ext. 2599 |
Ronald A. Cohen, MD |
|
Early Childhood Mental |
(510) 428-3885 ext. 5126 |
Lane Tanner, MD |
|
Emergency Department |
(510) 428-3259 |
Mary W. Rutherford, MD |
|
Emergency Department 2 |
(510) 428-3259 |
Mary W. Rutherford, MD |
|
Endocrinology/Diabetes |
(510) 428-3654 |
Jenny Olson, MD |
|
Family Outreach Support Clinic |
(510) 428-3129 |
Patricia Chase, MD |
|
Gastroenterology/ |
(510) 428-3885 ext. 2012 |
Elizabeth Gleghorn, MD |
|
Hand and Microsurgery |
(510) 428-3238 |
Scott Hoffinger, MD |
|
Hematology/Oncology |
(510) 428-3651 |
Elliott Vichinsky, MD |
|
Hospitalist |
(510) 428-3237 |
Ted Chaconas, MD |
|
Infectious Diseases |
(510) 428-3336 |
Ann Petru, MD |
|
International Adoption Clinic at Children's Hospital & Research Center Oakland |
(510) 428-3010 |
Nancy Curtis, MD |
|
Medical Genetics |
(510) 428-3885 ext. 2355 |
John Waterson, PhD, MD |
|
Neonatology/ |
(510) 428-3276 |
David Durand, MD |
|
Neonatal Follow-up Program |
(510) 428-3885 ext. 2299 |
Veronica Daly, MD |
|
Nephrology |
(510) 428-3335 |
Rose Ellen Morrell, MD |
|
Neurology |
(510) 428-3885 ext. 2912 |
Daniel Birnbaum, MD |
|
Neuropsychology Assessment |
(510) 428-3885 ext. 2912 |
Daniel Birnbaum, MD |
|
Neurosurgery |
(510) 428-3319 |
Peter Sun, MD |
|
Ophthalmology |
(510) 428-3050 |
Selim T. Koseoglu, MD |
|
Orthopaedics |
(510) 428-3238 |
Scott Hoffinger, MD |
|
Otorhinolaryngology |
(510) 428-3456 |
Robert Wesman, MD |
|
Pathology & Clinical Lab Medicine |
(510) 428-3530 |
Jon M. Rowland, MD, PhD |
|
Plastic Surgery |
(510) 428-3024 |
Stephen Daane, MD |
|
Primary Care Center |
(510) 428-3129 |
Patricia Chase, MD |
|
Psychiatry |
(510) 428-3354 |
Andrew Giammona, MD |
|
Pulmonary Medicine |
(510) 428-3305 |
Karen Hardy, MD |
|
Rehabilitation Medicine |
(510) 428-3655 |
Jacob Neufeld, MD, MSPH |
|
Sleep lab |
(510) 428-3305 |
Karen Hardy, MD |
|
Surgery |
(510) 428-3022 |
Sunghoon Kim, MD |
|
Synagis Clinic |
(510) 428-3885, ext. 2914 |
Karen Webb, NP |
|
Trauma Center |
(510) 428-3022 |
James Betts, MD |
|
Urgent Care |
(510) 428-3259 |
Mary W. Rutherford, MD |
|
Urology |
(510) 848-1727 |
Chi K. Lee, MD |
|
Email pageLearn More
- Insurance Plans
- Maps & Directions
Physician Liaison
liaisons@mail.cho.org
(510) 428-3043
Quality Department
PhysicianHelpline@ mail.cho.org
(510) 428-3828
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