Memory Loss (Amnesia/Short Term)

Diagnosis
Memory loss (amnesia/short term)
Department
Neurology

1. Start the referral process: 

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

Adult referral form 

2. Gather records:

  • Previous Neurology records
  • Abnormal MoCA, SLUMS or MMSE within last 6 months
  • Push all Brain imaging to OHSU PACS and include report 
  • Labs: B12, TSH, CBC, CSF, CMP
  • Neuropsych testing 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

For help or to arrange provider-to-provider advice, call 503-494-4567.

Date Revised May 16, 2022