Piriformis Syndrome
| Diagnosis |
Piriformis syndrome
|
|---|---|
| Department |
Comprehensive Pain Center; Spine Center
|
1. Start the referral process:
Use your own referral form or notes* or download our form:
2. Gather records:
For Comprehensive Pain Center:
- Detailed reason for referral and what is being requested to evaluate
- Last 3 months of chart notes
- CT/MRI/PT/xray or ultrasound imaging results
For Spine Center:
- Chart note including neurological exam
- Recent MRIs in IMPAX and report in EPIC
-
Treatment documentation for physical therapy (completion of at least 6 weeks)
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 |
|---|