Fletcher Allen, a Vermont university hospital and medical center, serves all of
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.
Breast Imaging
Locations:
Breast Care Center
Medical Center Campus
Level 2, Main Pavilion
111 Colchester Avenue, Burlington, VT 05401
Telephone: 802-847-2030
Fax: 802-847-8493
Scheduling Hours: Monday-Friday, 8:30 am-5:00 pm
Fanny Allen Campus, First Floor
790 College Parkway, Colchester, VT 05446
Telephone: 802-847-2446
Fax: 802-847-1387
Scheduling Hours: Monday-Friday, 8:00 am-4:30 pm
UHC Campus, First Floor
1 South Prospect Street, Burlington, VT 05401
Telephone: 802-847-2446
Fax: 802-847-1387
Scheduling Hours: Monday-Friday, 8:00 am-5:00 pm
Referral Information
This is information the Radiologist needs 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 and Issues For You 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.
c. Please describe the breast problems or state that 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 / Complete the Following:
1. Phone Consultation with Radiologist
2. Most Recent Lab Tests
3. Most Recent Office Note
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
