HOME > DOCTORS ENTRANCE > REFERRAL FORMS

Refer a Patient to Children's Hospital Oakland

 

Doctors Entrance

REFERRAL FORMS


To view and print PDF files you need Adobe's Acrobat Reader.

  1. Standard Patient Referral Form (See exceptions below: Clinic Referral Forms)

    1. Specialty Care Outpatient Clinic Appointments:
      1. Please check Preferred Location box at the top of the Standard Referral Form.
      2. Clinic Schedules

Clinic Referral Forms:

  1. Emergency Department Referral Form

  2. Diagnostic Imaging Referral & Order Form

  3. Pulmonary Function Test Request Form

  4. Mental Health & Child Development Referral Form
    1. Insurance Card: Include a fax copy (front and back) of your insurance card.
    2. Authorization: If insurance authorization is required for Mental health services, the referring provider/primary care physician is required to obtain the first initial authorization in order for us to set up the appointment.
    3. Review Period: Allow a 2-week review process before calling to schedule an appointment.
    4. Medical Records: Fax any additional medical records
    5. Complete the entire referral form to avoid any further delays.
    6. Questions—please contact us at 510-824-8428.

Patient Information Card:
Download an Appointment Information Card 
to give all the referral information to your patient.

Referral Directory Requests:
Contact Physician Liaison Services
: liaisons@mail.cho.org
(510) 428-3043

Who do I call with questions?
Call Physician Liaison Services at: 510-428-3043

How to Refer a Patient >

>Subscribe to e-news

>Become an advocate

>Volunteer

>Make a donation

>Buy a gift for a patient

>Get Directions

>Careers

>News Room

>Publications

  •  + Favorite
  • Email page
  • Print page
  •     Contact us