Sciatica Without Neurological Deficits

Diagnosis
Sciatica without neurological deficits
Department
Comprehensive Pain Center; Spine Center

1. Start the referral process:

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

Adult referral form

2. Gather records:

For Comprehensive Pain Center:

  • Detailed reason for referral & 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
  • MRI completed within the past year 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