Request For Consultation University Of Michigan Health System (Page 2 of 2) in pdf

Request For Consultation University Of Michigan Health System Page 2

Department of Internal Medicine

Division of Rheumatology

1500 E. Medical Center Drive

Ann Arbor, MI 48109-5358

M-LINE: 1-800-962-3555

Clinic: 734-647-5900

Fax: 734-936-8067

Dear Colleague:

Thank you for referring your patient to the University of Michigan Health System’s

Department of Internal Medicine, Division of Rheumatology. We value our relationship

with you and appreciate your confidence in our service and staff.

It is our goal to provide your patient with the highest quality of care in the most efficient

manner. To expedite the referral process, we would appreciate your assistance in

completing the attached referral request form and providing us with the following

information:

• Office Notes: Including current blood work and doctor notes that relate to the

rheumatologic diagnosis. (Written or dictated notes are essential.)

• Diagnostic Reports (All films should be hand carried by the patient to their clinic

appointment.)

• If the patient has a managed care insurance provider, a referral is required before

an appointment can be scheduled. For insurance that requires a referral or

authorization from the primary care physician, please fax the referral to our

document control center at 734-936-8067.

The information listed above is required before an appointment can be scheduled. As

soon as we receive this information, our office will review the medical documentation to

determine the appropriate clinic for scheduling. The process may take between 5-10

working days. If we do not receive completed information, it may delay the referral

process or scheduling of the appointment.

Once the appointment has been scheduled, we will mail an appointment notice to the

patient.

Again, we greatly appreciate your confidence in referring your patient to our service.

Cordially,

David A. Fox, M.D.

Professor and Division Chief, Rheumatology

Request For Consultation University Of Michigan Health System Page 2