Referral Forms for Providers

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</a> </div> <small class="text-left"> <a href="/mychart" > Learn More </a> | <a href="/mychart#section-145206" > Request a Login </a> </small> </div> </div> <section class="region region-subsite-navigation"> <div class="views-element-container block block-views block-views-blocksubsite-menu-block-1" id="block-views-block-subsite-menu-block-1"> <div class="content"> <div><div class="view view-subsite-menu view-id-subsite_menu view-display-id-block_1 js-view-dom-id-b39ca44458751a803e6fad2196812f0fefbbde31a9d899cb66f0443815d34b90"> <nav class="subnav subnav--subsite"> <div class="subnav__navbar"> <div class="subnav__title"> <a href=/doctors-providers> <span>For Doctors & Providers</span> </a> </div> <div class="subnav__content"> <nav class="subnav__desktop-items"> <li class="nav-item"> <div class="subnav-item"> <a id="subnav-item-21481" class="subnav-item__link" href="/referral" > Refer a Patient </a> </div> </li> <li class="nav-item"> <div class="subnav-item"> <a id="subnav-item-21491" class="subnav-item__link" href="/medical-professionals/physician-portal" > EpicCare Link </a> </div> </li> <li class="nav-item dropdown"> <div class="subnav-item"> <a id="subnav-item-21176" class="subnav-item__link" href="/doctors-providers/provider-resources" > Provider Resources </a> <button class="subnav-item__toggle dropdown-toggle" data-toggle="dropdown" data-flip="false" aria-haspopup="true" aria-expanded="false" role="button" tabindex="0" > <i class="fas fa-angle-down"></i> </button> <div class="dropdown-menu dropdown-menu-left" aria-labelledby="subnav-item-21176" > <ul> <li data-parentid="21176" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/physician-liaison-program" > <span>Physician Liaisons</span> </a> </div> </li> <li data-parentid="21176" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/provider-resources/ukmds" > <span>UK•MDs</span> </a> </div> </li> </ul> </div> </div> </li> <li class="nav-item dropdown"> <div class="subnav-item"> <a id="subnav-item-21756" class="subnav-item__link" href="/doctors-providers/advanced-practice-providers" > APPs </a> <button class="subnav-item__toggle dropdown-toggle" data-toggle="dropdown" data-flip="false" aria-haspopup="true" aria-expanded="false" role="button" tabindex="0" > <i class="fas fa-angle-down"></i> </button> <div class="dropdown-menu dropdown-menu-left" aria-labelledby="subnav-item-21756" > <ul> <li data-parentid="21756" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/advanced-practice-providers/directory" > <span>APP Directory</span> </a> </div> </li> <li data-parentid="21756" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/advanced-practice-providers/resources" > <span>APP Resources</span> </a> </div> </li> <li data-parentid="21756" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/advanced-practice-providers/spotlight" > <span>APP Spotlight</span> </a> </div> </li> <li data-parentid="21756" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/advanced-practice-providers/EM-APP-postgrad-training" > <span>UK Emergency Medicine APP Postgraduate Training</span> </a> </div> </li> </ul> </div> </div> </li> <li class="nav-item dropdown"> <div class="subnav-item"> <a id="subnav-item-21236" class="subnav-item__link" href="/doctors-providers/nursing" > Nursing </a> <button class="subnav-item__toggle dropdown-toggle" data-toggle="dropdown" data-flip="false" aria-haspopup="true" aria-expanded="false" role="button" tabindex="0" > <i class="fas fa-angle-down"></i> </button> <div class="dropdown-menu dropdown-menu-left" aria-labelledby="subnav-item-21236" > <ul> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center" > <span>Career Center</span> </a> <button class="subnav-item__toggle" type="button" data-itemid="21516" aria-expanded="false" aria-label="Toggle navigation" > <i class="fas fa-angle-down"></i> </button> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/peo-program-continuing-education-pce" > <span>The P.E.O. Program for Continuing Education (PCE)</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/lunch-learn-2021" > <span>Lunch & Learn 2022</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/dream-job" > <span>How to Land Your Dream Nursing Job</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/out-of-state" > <span>How to Land Your Dream Job Out of State</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/shadowing" > <span>What is Shadowing?</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/job-fair" > <span>Preparing for a Nursing Job or Career Fair</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/networking" > <span>Networking and Informational Interviews</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/interview-checklist" > <span>Are You Ready for Your Big Interview? Nursing Checklist</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/interview-questions" > <span>Sample Interview Questions</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/dress" > <span>Dress for Success at Your Nursing Interview</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/thank-you" > <span>General Content for a Thank You Letter After a Job Interview</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/references" > <span>General Information for References</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/letter" > <span>Sample Reference Letter</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/resignation" > <span>General Content for a Resignation Letter</span> </a> </div> </li> <li data-parentid="21516" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/career-center/past-lunch-and-learn" > <span>Past Lunch and Learn Presentations</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/community-outreach" > <span>Nursing Community Outreach</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education" > <span>Nursing Education</span> </a> <button class="subnav-item__toggle" type="button" data-itemid="21466" aria-expanded="false" aria-label="Toggle navigation" > <i class="fas fa-angle-down"></i> </button> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/residency-program" > <span>Nurse Residency Program</span> </a> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/continuing-education" > <span>Continuing Education</span> </a> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/faculty-orientation" > <span>Undergraduate Nursing Student Placement</span> </a> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/staff-development" > <span>Staff Development</span> </a> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/registered-nurse-internships" > <span>RN Internships</span> </a> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/snap" > <span>SNAP</span> </a> </div> </li> <li data-parentid="21466" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-education/tuition-assistance" > <span>Nurse Tuition Assistance Programs</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/positions" > <span>Nursing Positions</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/leadership" > <span>Nursing Leadership</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas" > <span>Patient Care Areas</span> </a> <button class="subnav-item__toggle" type="button" data-itemid="20256" aria-expanded="false" aria-label="Toggle navigation" > <i class="fas fa-angle-down"></i> </button> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/acute-care" > <span>Acute Care</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/behavioral-health" > <span>Behavioral Health</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/central-monitoring-system" > <span>Central Monitoring System</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/critical-care" > <span>Critical Care</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/emergency-services" > <span>ED Trauma</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/maternal-care" > <span>Maternal Care Areas</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/medical-professionals/nursing/nursing-patient-care-areas/cancer" > <span>Oncology Nursing</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/kentucky-childrens-hospital" > <span>Pediatrics</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/per-diem" > <span>Per Diem Pool</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/perioperative" > <span>Perioperative</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/rapid-response" > <span>Rapid Response</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/special-services" > <span>Special Services</span> </a> </div> </li> <li data-parentid="20256" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/transplant" > <span>Ambulatory Care</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice" > <span>Professional Practice</span> </a> <button class="subnav-item__toggle" type="button" data-itemid="19276" aria-expanded="false" aria-label="Toggle navigation" > <i class="fas fa-angle-down"></i> </button> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-patient-care-areas/advanced-practice" > <span>Advanced Practice</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/medical-professionals/nursing/nursing-professional-practice/awards-honors" > <span>Awards & Honors</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/medical-professionals/nursing/nursing-professional-practice/care-delivery-model" > <span>Care Delivery Model</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice/certifications" > <span>Certifications</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice/clinical-nurse-expert" > <span>Clinical Nurse Expert</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice/professional-advancement" > <span>Professional Advancement</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice/professional-practice-model" > <span>Professional Practice Model</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice/research" > <span>Research</span> </a> </div> </li> <li data-parentid="19276" class="nested-nav" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/nursing/nursing-professional-practice/service-line-triads" > <span>Trauma and Acute Care Surgery Triad</span> </a> </div> </li> <li data-parentid="21236" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/medical-professionals/nursing/public-notice-american-nurses-credentialing-center" > <span>Magnet Recognition Notice</span> </a> </div> </li> </ul> </div> </div> </li> <li class="nav-item dropdown"> <div class="subnav-item"> <a id="subnav-item-19231" class="subnav-item__link" href="/doctors-providers/manage-your-profile-photo" > Manage Profile </a> <button class="subnav-item__toggle dropdown-toggle" data-toggle="dropdown" data-flip="false" aria-haspopup="true" aria-expanded="false" role="button" tabindex="0" > <i class="fas fa-angle-down"></i> </button> <div class="dropdown-menu dropdown-menu-left" aria-labelledby="subnav-item-19231" > <ul> <li data-parentid="19231" class="nested-nav nested-nav--root" > <div class="nested-nav__item"> <a class="nested-nav__link" href="/doctors-providers/update-your-profile-instructions" > <span>How to update your photo or profile</span> </a> </div> </li> </ul> </div> </div> </li> <li class="nav-item"> <div class="subnav-item"> <a id="subnav-item-11088" class="subnav-item__link" href="/doctors-providers/trauma" > Trauma Program Office </a> </div> </li> </nav> <button class="subnav__mobile-toggle" type="button" data-toggle="collapse" data-target="#subsite-mobile-collapse" aria-controls="subsite-mobile-collapse" aria-expanded="false" aria-label="Toggle navigation" > MENU <i class="fas fa-angle-down"></i> </button> </div> </div> <ul class="collapse subnav__mobile-collapse" id="subsite-mobile-collapse"> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/referral" > Refer a Patient </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/medical-professionals/physician-portal" > EpicCare Link </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/provider-resources" > Provider Resources </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-21176" aria-controls="mobile-item-21176" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-21176" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/physician-liaison-program" > Physician Liaisons </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/provider-resources/ukmds" > UK•MDs </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/advanced-practice-providers" > APPs </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-21756" aria-controls="mobile-item-21756" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-21756" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/advanced-practice-providers/directory" > APP Directory </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/advanced-practice-providers/resources" > APP Resources </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/advanced-practice-providers/spotlight" > APP Spotlight </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/advanced-practice-providers/EM-APP-postgrad-training" > UK Emergency Medicine APP Postgraduate Training </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing" > Nursing </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-21236" aria-controls="mobile-item-21236" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-21236" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center" > Career Center </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-21516" aria-controls="mobile-item-21516" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-21516" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/peo-program-continuing-education-pce" > The P.E.O. Program for Continuing Education (PCE) </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/lunch-learn-2021" > Lunch & Learn 2022 </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/dream-job" > How to Land Your Dream Nursing Job </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/out-of-state" > How to Land Your Dream Job Out of State </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/shadowing" > What is Shadowing? </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/job-fair" > Preparing for a Nursing Job or Career Fair </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/networking" > Networking and Informational Interviews </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/interview-checklist" > Are You Ready for Your Big Interview? Nursing Checklist </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/interview-questions" > Sample Interview Questions </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/dress" > Dress for Success at Your Nursing Interview </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/thank-you" > General Content for a Thank You Letter After a Job Interview </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/references" > General Information for References </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/letter" > Sample Reference Letter </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/resignation" > General Content for a Resignation Letter </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/career-center/past-lunch-and-learn" > Past Lunch and Learn Presentations </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/community-outreach" > Nursing Community Outreach </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education" > Nursing Education </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-21466" aria-controls="mobile-item-21466" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-21466" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/residency-program" > Nurse Residency Program </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/continuing-education" > Continuing Education </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/faculty-orientation" > Undergraduate Nursing Student Placement </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/staff-development" > Staff Development </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/registered-nurse-internships" > RN Internships </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/snap" > SNAP </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-education/tuition-assistance" > Nurse Tuition Assistance Programs </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/positions" > Nursing Positions </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/leadership" > Nursing Leadership </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas" > Patient Care Areas </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-20256" aria-controls="mobile-item-20256" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-20256" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/acute-care" > Acute Care </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/behavioral-health" > Behavioral Health </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/central-monitoring-system" > Central Monitoring System </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/critical-care" > Critical Care </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/emergency-services" > ED Trauma </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/maternal-care" > Maternal Care Areas </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/medical-professionals/nursing/nursing-patient-care-areas/cancer" > Oncology Nursing </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/kentucky-childrens-hospital" > Pediatrics </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/per-diem" > Per Diem Pool </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/perioperative" > Perioperative </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/rapid-response" > Rapid Response </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/special-services" > Special Services </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/transplant" > Ambulatory Care </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice" > Professional Practice </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-19276" aria-controls="mobile-item-19276" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-19276" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-patient-care-areas/advanced-practice" > Advanced Practice </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/medical-professionals/nursing/nursing-professional-practice/awards-honors" > Awards & Honors </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/medical-professionals/nursing/nursing-professional-practice/care-delivery-model" > Care Delivery Model </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice/certifications" > Certifications </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice/clinical-nurse-expert" > Clinical Nurse Expert </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice/professional-advancement" > Professional Advancement </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice/professional-practice-model" > Professional Practice Model </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice/research" > Research </a> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/nursing/nursing-professional-practice/service-line-triads" > Trauma and Acute Care Surgery Triad </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/medical-professionals/nursing/public-notice-american-nurses-credentialing-center" > Magnet Recognition Notice </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/manage-your-profile-photo" > Manage Profile </a> <button class="subnav__mobile-expand" data-toggle="collapse" data-target="#mobile-item-19231" aria-controls="mobile-item-19231" > <i class="far fa-lg fa-angle-down"></i> </button> </div> <div id="mobile-item-19231" class="collapse" > <ul class="subnav__mobile-collapse" tabindex="-1" > <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/update-your-profile-instructions" > How to update your photo or profile </a> </div> </li> </ul> </div> </li> <li class="nav-item"> <div class="nav-item__expandable"> <a class="expandable__link" href="/doctors-providers/trauma" > Trauma Program Office </a> </div> </li> </ul> </nav> </div> </div> </div> </div> </section> </div> <div role="main" class="page page--journey"> <div role="heading"> <div data-drupal-messages-fallback class="hidden"></div> </div> <section class="main-content" id="content" role="main"> <a id="main-content"></a> <div id="block-ukhc-content" class="block block-system block-system-main-block"> <div class="content"> <article data-history-node-id="21481" about="/referral" class="node node--type-general-page node--view-mode-full clearfix"> <header> </header> <div class="node__content clearfix"> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="block block-system block-system-breadcrumb-block"> <div class="content"> <nav role="navigation" aria-label="breadcrumb" class="breadcrumb-wrapper" > <div class="breadcrumb__inner onecol-container"> <ol class="breadcrumb"> <li class="breadcrumb-item"> <a href="/">Home</a> </li> <li class="breadcrumb-item active"> Refer a Patient </li> </ol> <div class="breadcrumb__sharebuttons"> <div id="block-addtoanybuttons" class="block block-addtoany block-addtoany-block"> <div class="content"> <span class="a2a_kit a2a_kit_size_32 addtoany_list" data-a2a-url="https://ukhealthcare.uky.edu/referral" data-a2a-title="Referral Forms for Providers"><a class="a2a_button_facebook"></a><a class="a2a_button_x"></a><a class="a2a_button_linkedin"></a><a class="a2a_button_copy_link notransition-onresize"><div class="copy-link"><i class="fas fa-link"></i></div><div class="copy-success"><i class="fa fa-check"></i></div></a></span> </div> </div> </div> </div> </nav> </div> </div> <div class="block block-layout-builder block-field-blocknodegeneral-pagefield-administrative-notes"> <div class="content"> </div> </div> <div class="block block-layout-builder block-extra-field-blocknodegeneral-pagecontent-moderation-control"> <div class="content"> </div> </div> <div class="block block-layout-builder block-field-blocknodegeneral-pagetitle"> <div class="content"> <div class="onecol-container"> <h1 class="node__title"> Referral Forms for Providers </h1> </div> </div> </div> <div class="block block-layout-builder block-field-blocknodegeneral-pagefield-components"> <div class="content"> <div class="node-components"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><blockquote> <p>Thank you for referring your patient to UK HealthCare. EpicCare Link is the preferred method for submitting referrals. It significantly expedites the referral process by going directly into the scheduling work queue and is less time consuming and easier to submit.</p> <p>If you do not have EpicCare Link access, please contact your Link Site Administrator at your location or request access. In order for staff to be able to submit referrals and for patients to be connected back to your practice, each provider needs a completed EpicCare Link application even if they are not going to utilize the system. It can take up to three weeks for new user applications to be processed. Once IT has set up your account, your log in credentials will be emailed to you. In the interim, you can continue to use the Refer a Patient button below or call UKMDs at <a href="tel:800-888-5533">800-888-5533</a>; however, the plan is to discontinue faxing and the web-based referral form once users are set up on EpicCare Link.</p> <p><a class="button" href="/provider-referral-form">Refer a Patient</a> <a class="button" href="https://link.uky.edu">EpicCare Link Log In</a> <a class="button--secondary" href="https://link.uky.edu/EpicCareLink/common/account_request_main.asp">EpicCare Link Access Request</a></p> <p>For more information regarding EpicCare Link, please download the document below or contact the Physician Liaison Program at <a href="tel:859-323-0736">859-323-0736</a>.</p> <div class="media--document" data-link-text="EpicCare Link Information Sheet (PDF, 404.39 KB)"> <a href="/sites/default/files/m21-0568.3_epiccare_link_flyerv5_final.pdf" target="_blank"> EpicCare Link Information Sheet (PDF, 404.39 KB) </a> </div> <div class="clearfix"></div> </blockquote> <h2>Department-specific referral forms</h2> <p>EpicCare Link is the preferred method for submitting referrals. It significantly expedites the referral process by going directly into the scheduling work queue and is less time consuming and easier to submit. If you currently do not have access to EpicCare Link, you may complete and submit the department-specific forms below until your EpicCare Link application is approved and your log in credentials are received.</p> <p><strong>If you complete one of the department-specific forms, you do not need to submit any other type of referral form. Only use one method to submit a referral.</strong></p> <p>If you are a patient, please use our <a href="/appointment">appointment form</a>.</p> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-72746"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110016" aria-expanded="false" aria-controls="collapse-110016" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Diabetes Care</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110016" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Diabetes Care</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><div class="media--document" data-link-text="Diabetes Prevention Program (Prediabetes) (PDF, 125 KB)"> <a href="/sites/default/files/diabetes-prevention-program-referral-form.pdf" target="_blank"> Diabetes Prevention Program (Prediabetes) (PDF, 125 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Diabetes Self Management Education (Type 1, Type 2 and Gestational) (PDF, 146 KB)"> <a href="/sites/default/files/diabetes-education-training-referral-form_0.pdf" target="_blank"> Diabetes Self Management Education (Type 1, Type 2 and Gestational) (PDF, 146 KB) </a> </div> <div class="clearfix"></div> </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61521"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110021" aria-expanded="false" aria-controls="collapse-110021" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Endocrine Surgery</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110021" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Endocrine Surgery</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><ul> <li> <div class="media--document" data-link-text="Endocrine Surgery Consultation Request Form (PDF, 204.61 KB)"> <a href="/sites/default/files/2022-11/Referral%20Form%20Updated%204%207%202022.pdf" target="_blank"> Endocrine Surgery Consultation Request Form (PDF, 204.61 KB) </a> </div> <div class="clearfix"></div> </li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61531"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110026" aria-expanded="false" aria-controls="collapse-110026" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Endoscopy Service</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110026" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Endoscopy Service</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><div class="media--document" data-link-text="Endoscopy Order Form (PDF, 33 KB)"> <a href="/sites/default/files/open-access-order-upper-and-lower-endoscopy-referral.pdf" target="_blank"> Endoscopy Order Form (PDF, 33 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Advanced Endoscopy Scheduling Form (PDF, 44 KB)"> <a href="/sites/default/files/advanced-endocopy-scheduling-form.pdf" target="_blank"> Advanced Endoscopy Scheduling Form (PDF, 44 KB) </a> </div> <div class="clearfix"></div> </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-89616"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110031" aria-expanded="false" aria-controls="collapse-110031" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Gill Heart & Vascular Institute</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110031" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Gill Heart & Vascular Institute</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li> <div class="media--document" data-link-text="Anticoagulation Clinic Referral Form (PDF, 25 KB)"> <a href="/sites/default/files/gill-anticoagulation-clinic-referral-form-aehr-page-1.pdf" target="_blank"> Anticoagulation Clinic Referral Form (PDF, 25 KB) </a> </div> <div class="clearfix"></div> </li> <li> <div class="media--document" data-link-text="Referring Patients to Cardiovascular Sub-Specialty Clinics (PDF, 40.2 KB)"> <a href="/sites/default/files/gill-specialty-clinic-referral-guide.pdf" target="_blank"> Referring Patients to Cardiovascular Sub-Specialty Clinics (PDF, 40.2 KB) </a> </div> <div class="clearfix"></div> </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-102561"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110036" aria-expanded="false" aria-controls="collapse-110036" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Interventional Pain Medicine referral form</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110036" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Interventional Pain Medicine referral form</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><a href="/form/ipm-physician-referral-form">Interventional Pain Medicine patient referral form »</a></li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61541"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110041" aria-expanded="false" aria-controls="collapse-110041" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Markey Cancer Center</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110041" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Markey Cancer Center</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><ul> <li><a href="/markey-cancer-center/refer-a-patient/clinical-genetic-counseling">Clinical Genetic Counseling Referral Guidelines</a></li> <li> <div class="media--document" data-link-text="Clinical Genetic Counseling Referral Form (PDF, 603 KB)"> <a href="/sites/default/files/2024-01/Referral%20Form%2012.2023.pdf" target="_blank"> Clinical Genetic Counseling Referral Form (PDF, 603 KB) </a> </div> <div class="clearfix"></div> </li> <li><a href="/markey-cancer-center/research/mtb#section-7091" title="Molecular Tumor Board Referral">Molecular Tumor Board Referral</a> - Learn more about the Molecular Tumor Board and submitting a patient's case.</li> <li><a href="/markey-cancer-center/research/pmc/referral">Precision Medicine Clinic Referral Form</a></li> <li> <div class="media--document" data-link-text="Hematology/BMT Referral Form (PDF, 71KB)"> <a href="/sites/default/files/hematology-bmt-clinic-referral-form.pdf" target="_blank"> Hematology/BMT Referral Form (PDF, 71KB) </a> </div> <div class="clearfix"></div>  - Refer your patients to Markey's Hematology and BMT Clinic using the attached form. Please fax completed forms to 859-323-5822.</li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-122161"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110046" aria-expanded="false" aria-controls="collapse-110046" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Nephrology Hypertension</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110046" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Nephrology Hypertension</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><p>To make a patient referral, please complete the following form and fax it to 859-257-0260.</p> <div contenteditable="false" tabindex="-1"> <div class="media--document" data-link-text="Nephrology Hypertension Referral form (PDF, 62 KB)"> <a href="/sites/default/files/nephrology-hypertension-referral-form.pdf" target="_blank"> Nephrology Hypertension Referral form (PDF, 62 KB) </a> </div> <div class="clearfix"></div> </div></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61561"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110051" aria-expanded="false" aria-controls="collapse-110051" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Neurosurgery</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110051" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Neurosurgery</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><a href="/kentucky-neuroscience-institute/neurosurgery/referral">Neurosurgery Referral Form</a></li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-145771"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110056" aria-expanded="false" aria-controls="collapse-110056" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Ophthalmic Genetics Clinic</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110056" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Ophthalmic Genetics Clinic</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><div class="media--document" data-link-text="Ophthalmic Genetics Clinic Referral Form (PDF, 58 KB)"> <a href="/sites/default/files/m21-0669_oph_ophthamlic_genetic_referral_form_web_final.pdf" target="_blank"> Ophthalmic Genetics Clinic Referral Form (PDF, 58 KB) </a> </div> <div class="clearfix"></div> </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-148121"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110061" aria-expanded="false" aria-controls="collapse-110061" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Glaucoma</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110061" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Glaucoma</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><div contenteditable="false" tabindex="-1"> <div class="media--document" data-link-text="Glaucoma Referral Form (PDF, 124KB)"> <a href="/sites/default/files/ophthalmology-referral-form-07-27-2021.pdf" target="_blank"> Glaucoma Referral Form (PDF, 124KB) </a> </div> <div class="clearfix"></div> </div></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61761"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110066" aria-expanded="false" aria-controls="collapse-110066" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Pediatrics</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110066" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Pediatrics</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><ul> <li> <div class="media--document" data-link-text="Pediatric Sedation Request Form (PDF, 27 KB)"> <a href="/sites/default/files/pediatric-sedation-referral-request.pdf" target="_blank"> Pediatric Sedation Request Form (PDF, 27 KB) </a> </div> <div class="clearfix"></div> </li> <li> <div class="media--document" data-link-text="External Pediatric Referral COVID-19 Forms (PDF, 1.2 MB)"> <a href="/sites/default/files/external_referral_pediatric_covid-19_forms.pdf" target="_blank"> External Pediatric Referral COVID-19 Forms (PDF, 1.2 MB) </a> </div> <div class="clearfix"></div> </li> <li> <div class="media--document" data-link-text="Developmental Pediatrics Referral Information (PDF, 77.8 KB)"> <a href="/sites/default/files/2023-08/kch-dev-peds-referral_0823.pdf" target="_blank"> Developmental Pediatrics Referral Information (PDF, 77.8 KB) </a> </div> <div class="clearfix"></div> </li> <li> <div class="media--document" data-link-text="NICU Graduate Clinic (PDF, 44.77 KB)"> <a href="/sites/default/files/2024-09/nicu-grad-referral-august2024.pdf" target="_blank"> NICU Graduate Clinic (PDF, 44.77 KB) </a> </div> <div class="clearfix"></div> </li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61551"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110071" aria-expanded="false" aria-controls="collapse-110071" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Pharmacy</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110071" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Pharmacy</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><div class="media--document" data-link-text="Cystic Fibrosis Patient Referral Form (PDF, 106 KB)"> <a href="/sites/default/files/pharmacy-cystic-fibrosis-referral-form.pdf" target="_blank"> Cystic Fibrosis Patient Referral Form (PDF, 106 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="GI-IBD Patient Referral Form (PDF, 104 KB)"> <a href="/sites/default/files/pharmacy-gi-patient-referral-form.pdf" target="_blank"> GI-IBD Patient Referral Form (PDF, 104 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Hepatitis-C Patient Referral Form (PDF, 152 KB)"> <a href="/sites/default/files/pharmacy-hep-c-patient-referral-form.pdf" target="_blank"> Hepatitis-C Patient Referral Form (PDF, 152 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Neurology Patient Referral Form (PDF, 104 KB)"> <a href="/sites/default/files/pharmacy-neurology-patient-referral-form.pdf" target="_blank"> Neurology Patient Referral Form (PDF, 104 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Oncology Patient Referral Form (PDF, 242 KB)"> <a href="/sites/default/files/pharmacy-patient-hem-onc-referral-form.pdf" target="_blank"> Oncology Patient Referral Form (PDF, 242 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Supplier Standards (PDF, 63 KB)"> <a href="/sites/default/files/supplier-standards-with-patient-rights.pdf" target="_blank"> Supplier Standards (PDF, 63 KB) </a> </div> <div class="clearfix"></div> </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61571"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110076" aria-expanded="false" aria-controls="collapse-110076" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Rheumatology</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110076" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Rheumatology</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li> <div class="media--document" data-link-text="Rheumatology referral form (PDF, 47KB)"> <a href="/sites/default/files/rheumatology-referral-form-07-23-2021.pdf" target="_blank"> Rheumatology referral form (PDF, 47KB) </a> </div> <div class="clearfix"></div> </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-61581"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110081" aria-expanded="false" aria-controls="collapse-110081" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Transplant Center</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110081" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Transplant Center</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden field--paragraph--field-components field__items"> <div class="field__item"> <div class="paragraph__component--html-content"> <div class="html-content__content"> <div class="clearfix text-formatted field field--name-field-html field--type-text-long field--label-hidden field--paragraph--field-html field__item"><body><ul><li><div class="media--document" data-link-text="Kidney/pancreas fax referral form (PDF, 113 KB)"> <a href="/sites/default/files/kidney-pancreas-transplant-consultation-form-fillable-09-2019.pdf" target="_blank"> Kidney/pancreas fax referral form (PDF, 113 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Vascular Access Consultation Request Form (PDF, 55 KB)"> <a href="/sites/default/files/vascular-access-consultation-request-form-fillable-2015-november.pdf" target="_blank"> Vascular Access Consultation Request Form (PDF, 55 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Liver Transplant Consultation Request Form (PDF, 75 KB)"> <a href="/sites/default/files/liver-transplant-hepatobiliary-surgery-form.pdf" target="_blank"> Liver Transplant Consultation Request Form (PDF, 75 KB) </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Heart Transplant and Ventricular Assist Device Referral Checklist (PDF, 122 KB) "> <a href="/sites/default/files/heart-transplant-referral-checklist-2018.pdf" target="_blank"> Heart Transplant and Ventricular Assist Device Referral Checklist (PDF, 122 KB)  </a> </div> <div class="clearfix"></div> </li> <li><div class="media--document" data-link-text="Heart Transplant and Ventricular Assist Device Consultation Request Form (PDF, 60 KB)"> <a href="/sites/default/files/heart-transplant-request.pdf" target="_blank"> Heart Transplant and Ventricular Assist Device Consultation Request Form (PDF, 60 KB) </a> </div> <div class="clearfix"></div>  </li> <li><div class="media--document" data-link-text="Lung Transplant Referral Form (PDF, 65 KB)"> <a href="/sites/default/files/lung-transplant-referral-form-2016-fillable_0.pdf" target="_blank"> Lung Transplant Referral Form (PDF, 65 KB) </a> </div> <div class="clearfix"></div>  </li> </ul></body></div> </div> </div> </div> </div> </div> </div> </div> <div class="ukhc-section paragraph paragraph--type--page-section paragraph--view-mode--default" id="section-86031"> <button class="collapse-header" type="button" data-toggle="collapse" data-target="#collapse-110086" aria-expanded="false" aria-controls="collapse-110086" > <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Wound Care Clinic</div> <i class="fas fa-angle-down"></i> </button> <div id="collapse-110086" class="collapse collapse--mobile" > <div class="collapse__inner"> <h2> <div class="field field--name-field-headline field--type-string field--label-hidden field--paragraph--field-headline field__item">Wound Care Clinic</div> </h2> <div class="field field--name-field-components field--type-entity-reference-revisions field--label-hidden 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