ANCA-Associated Vasculitis

ANCA-Associated Vasculitis: Granulomatosis with polyangiitis (Wegener's) (GPA); Microscopic polyangiitis (MPA); Eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome) (EGPA)

1. Start the referral process:

Use your own referral form or notes* or download our form:

Adult referral form

2. Gather records:

  • Recent chart notes supporting diagnosis
  • Chart notes from referring provider from past 2 years
  • Labs supporting the diagnosis
    • ESR or CRP
    • ANCA
  • Imaging supporting the diagnosis
  • Notes from rheumatologist if seen
  • Biopsy results if available

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