Anal Fistula

Diagnosis
Anal fistula
Department
Pediatric Surgery; Urology

1. Start the referral process:

Use your own referral form or notes* or download one of our forms:

2. Gather records:

For adult referrals, Urology:

  • Records from all providers previously treating Dx

For Pediatric Surgery:

  • Any records from PCP, or referring provider
  • Any imaging or tests done for this dx
  • Any past surgical records for this dx

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 for referral
Date Revised February 18, 2021