Radiation Oncology Referral Information

RADIATION ONCOLOGY
Radiation Oncology services are provided at Fletcher Allen’s Medical Center Campus.  The Radiation Oncology division is a consultative and treatment service for adults and pediatric cancer patients.  The service evaluates and provides external beam and brachytherapy treatment for all cancer cases.  The service offers Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT).

TO SCHEDULE AN APPOINTMENT

Telephone: (802) 847-3506

Fax: (802) 847-2386

Location:         
Shepardson Building, Level 2
Medical
Center Campus
111 Colchester Avenue
Burlington, VT 05401

Hours:
Monday-Friday, 7:30 am-4:30 pm

REFERRAL INFORMATION

The Radiation Oncologist needs the following information to provide the best care for your patient.

 Patient Demographic Information
Name, Date of Birth, Address, Phone Number, Insurance Plan

 Medical/Surgical Information
Most Important

1. Name of Referring MD/Provider / Phone / Fax
2. Reason for Referral: Signs and Symptoms (Very Important) 3. Medication / Allergy List
4. Previous Course of Treatment
5. Date of LMP for all Women within Childbearing Age
6. Patient’s Weight
7. Other Specific information as requested on referral form  

Questions & Issues to Consider When Referring Your Patients

1. Patients referred for Mammography 
    a. Please make sure the patient is referred to the appropriate  campus. Some campuses just do screening mammograms and others offer diagnostic procedures.

   b. Implants, cancerous lumpectomy patients, and problem cases should be scheduled at the UHC Campus, 1 South Prospect Street.

   c. Please describe the breast problems or state there are none.

   d. Specify if the patient has implants.

   e. Specify prior cancers.

   f.  Please identify any special needs the patient may have

         (i.e. in a wheelchair).  

For Interventional Procedures,  please send or complete the following:
1. Phone Consultation with Radiologist
2. Most Recent Lab Tests
3. Most Recent office notes

Please send the following information if it pertains to the referral. 1. Problem List
2. Medical / Surgical History
3. Hard Copy Images and Reports from outside Radiologists 4. Nuclear Medicine Reports
5. Procedure Reports
6. Prior Hospital Discharge Summaries and/or Operative Reports