Gross Hematuria

Diagnosis Gross hematuria
Department Pediatric Urology; 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:

  • ≥ 3RBC per HPF on UA with microscopy
  • Painless gross hematuria
  • CT Urogram, unless:
    • Pt has renal insufficiency
    • Pt has contrast allergy
    • Pt has had CT urogram w/o contrast last 6 months
  • Records from all providers previously treating Dx

For Pediatric Urology:

  • Obtain all previous urologic images, reports, PCP notes and UA cultures
  • Renal/Bladder Ultrasound, Urine Ca/Cr/Pr (clinic collect) needs voiding forms if potty trained, UA

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 01, 2024