Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Spine Institute of New England Referral Information
The Spine Institute of New England provides the most advanced diagnostic services and treatment programs for any form of upper and lower back problem, including back and neck pain, arthritis, trauma/fractures, curvatures or spinal deformities, tumors, and degenerative conditions.
TO SCHEDULE AN APPOINTMENT
Main Office #:
Orthopedic Specialty Center
192 Tilley Drive
South Burlington, VT 05403
Monday, Tuesday, Wednesday, Friday, 8:00 am-5:00 pm
Thursday, 9:00 am-5:00 pm
This is information the Orthopedic Surgeon needs to provide the best care for your patient.
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 and Diagnostics (MRIs, EMGs, CTs, Myleo-CTs), Films and Reports Pertaining to the Referral.
7. Previous Course of Treatment
8. If the Referral is Worker’s Compensation-Related, 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
1. 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