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
For help or to arrange provider-to-provider advice, call 503-494-4567.
| Date Revised | May 16, 2022 |
|---|