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REFERRAL GUIDE FOR PROVIDERS (CPT Codes & Authorization Information)

REFERRAL FORMS

Referral Triage Guide for COVID-19 Tests

COVID-19 drive-through testing is available at UCSF Benioff Children’s Hospitals by referral only.

Refer only pediatric patients who have:

  • Symptoms suggestive of COVID-19 who have not been tested recently 
  • High risks for complications and have been exposed to confirmed COVID-19 infected people

You may fax your referral to: (510) 450-7975

 

Sign in to MD Link if you already have a UCSF MD Link account.

To Create a UCSF MD Link Account 
  1. Go to UCSF Medical Center MD Link  and Click “Request New Account”
  2. Complete the form AND sign the DocuSign agreement.
  3. Expect an email with your new login and password within 3-5 days.
MD Link Questions

Referral Forms for Non-MD Linked Referrers

Referral FAX
(510) 985-2202

  1. Standard Referral (Use for any referral that does not have a specific Specialty-Referral form listed)
  2. Diagnostic Imaging, Radiology, MRI Referral
  3. Emergency Department Referral
  4. Fetal Medicine Program Referral
  5. Mental Health & Child Development Referral
  6. Occupational Therapy Patient Referral & Prescription Form
  7. Pediatric Rehabilitation Inpatient Referral
  8. Physical Therapy Patient Referral & Prescription Form
  9. Pulmonary Function Test Request
  10. Sleep Study Polysomnography Order and Request
  11. Speech Therapy Patient Referral & Prescription Form
For Urgent Referrals

Please go to the specialty department page and call the phone number listed to have the referring physician speak to the specialist on call.

Inpatient and Direct Admissions

How To Refer by Fax

1. Download Patient Referral Form above

2. Fax form and additional information to: (510) 985-2202 

3. Include:
  1. Authorization (if required)
  2. Medical Record Notes
  3. Operative Notes
  4. Diagnostic Imaging or Laboratory Results
Questions?

Transport and Inpatient Referral Information:

  • Transport to NICU, PICU, ED, or Inpatient
  • Inpatient Referrals / Direct Admission
  • Fax Referral Management Process

    Your fax is received and stored on a secure server. Your referral is then routed to the appropriate department for processing. 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.

    Outpatient 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) 985-2202 
      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.

    Physician Liaison Services:

    • Phone: (510) 428-3043
    • Email: Liaisons@mail.cho.org
    • 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 nurse practitioners 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: (510) 428-3043.

    REFERRAL GUIDE FOR PROVIDERS (CPT Codes & Authorization Information)

    REFERRAL FORMS

    Referral Triage Guide for COVID-19 Tests

    COVID-19 drive-through testing is available at UCSF Benioff Children’s Hospitals by referral only.

    Refer only pediatric patients who have:

    • Symptoms suggestive of COVID-19 who have not been tested recently 
    • High risks for complications and have been exposed to confirmed COVID-19 infected people

    You may fax your referral to: (510) 450-7975

     

    Sign in to MD Link if you already have a UCSF MD Link account.

    To Create a UCSF MD Link Account 
    1. Go to UCSF Medical Center MD Link  and Click “Request New Account”
    2. Complete the form AND sign the DocuSign agreement.
    3. Expect an email with your new login and password within 3-5 days.
    MD Link Questions

    Referral Forms for Non-MD Linked Referrers

    1. Standard Referral (Use for any referral that does not have a specific Specialty-Referral form listed)
    2. Diagnostic Imaging, Radiology, MRI Referral
    3. Emergency Department Referral
    4. Fetal Medicine Program Referral
    5. Mental Health & Child Development Referral
    6. Occupational Therapy Patient Referral & Prescription Form
    7. Pediatric Rehabilitation Inpatient Referral
    8. Physical Therapy Patient Referral & Prescription Form
    9. Pulmonary Function Test Request
    10. Sleep Study Polysomnography Order and Request
    11. Speech Therapy Patient Referral & Prescription Form

    How To Refer by Fax

    1. Download Patient Referral Form above

    2. Fax form and additional information to: (510) 985-2202 

    3. Include:
    1. Authorization (if required)
    2. Medical Record Notes
    3. Operative Notes
    4. Diagnostic Imaging or Laboratory Results

    Transport and Inpatient Referral Information

  • Transport to NICU, PICU, ED, or Inpatient
  • Inpatient Referrals / Direct Admission
  • Questions?

    Fax Referral Management Process

    Your fax is received and stored on a secure server. Your referral is then routed to the appropriate department for processing. 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.

    Outpatient 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) 985-2202 
      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.

    Physician Liaison Services:

    • Phone: (510) 428-3043
    • Email: Liaisons@mail.cho.org
    • 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 nurse practitioners 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: (510) 428-3043.