Epilepsy Referral Information

COMPREHENSIVE EPILEPSY CENTER
The epilepsy program specializes in assisting patients with the myriad issues affecting persons with epilepsy and related disorders. The team consists of adult and pediatric epileptologists, a neuropsychologist, a neurosurgeon and a neuroradiologist who work to obtain the highest quality care including accurate diagnosis (including epilepsy monitoring), optimal treatment regimens, counseling, drug research trials and epilepsy surgery.

Location:

Patrick Building, Level 5
Medical Center Campus
111 Colchester Ave.
Burlington, VT 05401

Telephone:
802-847-2788

Fax:

802-847-5679

Office Hours:

Monday-Friday, 8 am to 5 pm

REFERRAL INFORMATION
This is information the Neurologist needs to provide the best care for your patient.

Questions and Issues For You to Consider When Referring Your Patients
1.     Please ask patient to bring all their medications and personal medical records
    to the appointment.
2.     Patients referred for Spasmodic Dysphonia should also have an ENT consult scheduled prior to the visit with the Neurologist.
3.     If there is a current exacerbation due to Multiple Sclerosis, please refer the patient.

Medical/Surgical Information
Most Important
1.     Name of Referring MD/Provider / Phone / Fax
2.     Reason for Referral and Expectations
3.     Most Recent Office Note Pertaining to the Visit
4.     Medication / Allergy List
5.     Previous Course of Treatment
6.     EEG
7.     Most Recent Lab Tests
8.     Imaging Films and Reports of Head, Neck or Spine Including MRI, CT, Angio,
    SPECT, PET and /or Myelogram

Please send the following information if pertinent to the referral.
1.     Outside Consult Reports
2.     Hospital Discharge Summary and Medications
3.     Pathology Reports
4.     Laboratory/Blood Urine Test Results
5.     Results of Electrophysiology Testing

Please send the following information if possible. It is desirable, not essential.
1.     Problem List
2.     Medical / Surgical History
3.     Nuclear Medicine Reports
4.     Operative Reports if Pertinent

Diagnosis-Specific Information

1.     Cervical Dystonia and other Focal Dystonias:  Please Send Serum Ceruloplasm
2.     Multiple Sclerosis:  Please Send Lumbar Puncture Results if Already Performed, Evoked Potential Studies, Neuroimaging

Patient Demographic Information

Name, Date of Birth, Address, Phone Number, Insurance Plan, Worker’s Compensation, if applicable