Retinoblastoma

Diagnosis
Retinoblastoma
Department
Casey Eye Institute

1. Start the referral process:

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

Adult referral form

2. Gather records:

  • Chart notes including examination findings
  • Ophthalmic imaging, including photos and ultrasound images (digital copies preferred)
  • Relevant MRI/CT reports
  • Pathology reports

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