For referring providers
Please include the following with your referral:
- Demographics
- Labs & Tests Supporting Diagnoses
- Office/Progress Notes
- Complete blood count (CBC) and iron studies, such as ferritin or iron level, indicating iron deficiency or anemia within six months of starting therapy.
- If sending over someone with “WNL” lab values- documentation of explanation of why treatment is being ordered/recommended will be required.
Submit an e-referral →Download the PDF form
