Referral Information for Bone & Joint Care

TO SCHEDULE AN APPOINTMENT

Scheduling #:   
(802) 847-6000 
   
Main Office #:   
(802) 847-2663   
Fax:       
(802) 847-7470

Location:   
Orthopedic Specialty Center
192 Tilley Drive
South Burlington, VT 05403

Office Hours:   
Monday, Tuesday, Wednesday, Friday, 8:00 am-5:00 pm
Thursday, 9:00 am-5:00 pm

Referral Information
The Orthopedic Surgeon needs the following referral information to provide the best care for your patient.

Medical/Surgical Information
Most Important:
1. Name of Referring MD/Provider/Phone/Fax
2. Reason for Referral and Expectations
3. Problem List
4. Medical/Surgical History
5. Medication/Allergy List
6. Most Recent office notes pertaining to the referral.
7. Previous Course of Treatment
8. If the Referral is Worker's Compensation-related, please send    Worker's Compensation summary defining why referred and desired outcome.

Please send the following information, if pertinent to the referral.
1. Outside Consult Reports
2. Operative Reports
3. All Imaging Reports
4  All Hard Copy Images
5. Nuclear Medicine Reports
6. Procedure Reports

Please send the following information, if relevant.
1. Hospital Discharge and Medication Summaries
2. Most Recent Pathology Reports

Diagnosis-Specific Information
Trauma Patients:
Please Send: ED Reports; results of all pertinent diagnostic studies so tests do not need to be repeated.

Patient Demographic Information
Name, Date of Birth, Address, Phone Number, Insurance Plan, Worker's Compensation Information, if applicable.