Dysphagia

Diagnosis
Dysphagia
Department
Pediatric Gastroenterology; Otolaryngology and Head and Neck Surgery

1. Start the referral process:

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

2. Gather records:

For adult referrals, Otolaryngology and Head and Neck Surgery:

  • Any chart notes and imaging related to referral

For Pediatric Gastroenterology:

  • Growth chart
  • Labs
  • Imaging

    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 June 30, 2021