Atrioventricular Block: Mobitz (2nd Degree)

Atrioventricular block: Mobitz (2nd degree)

1. Start the referral process:

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

Adult referral form

2. Gather records:

  • ECG Reports and Tracings
  • Holter/event monitor with full disclosure
  • Echo Reports
  • Pacemaker/defibrillator notes
  • ECG+ additional testing pending medical review

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 providers 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 20, 2021