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How To Refer a Patient                                                                                    Department Directory >

Standard Referral Form:

  1. Standard Patient Referral Form

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 Complete the entire referral form to avoid any further delays. Include the following:

    1. Insurance Card: ( fax copy; front and back)
    2. Authorization: If insurance authorization is required for mental health services, the referring provider/primary care physician is required to obtain the initial authorization in order for us to schedule the appointment.
    3. Medical Records: Fax all relevant medical records.
    4. Review Period: Allow a 2-week review process before calling to schedule an appointment. Questions? Please contact us at: 510-824-8428

Download the appropriate Patient Referral Form.

Fax the completed referral form to: (510) 995-2955
or: (510) 995-2956

Use the Standard Referral Form with the exception of the four clinic referral forms listed below. (Emergency, DI, Pulmonary, Mental Health)

Specialty Care Clinics
When requesting Specialty Care Outpatient Clinic Appointments:

  1. At the top of the Standard Referral Form, please check Preferred Location box.

  2. View: Subspecialty Clinic Schedule

New Patient Referrals

Please include the following 6 items:

  1. Physician Name, Office Address, Phone and Fax Number
  2. Patient Name, Date of Birth and Parent or Guardian's Name
  3. Reason for Referral
  4. Clinic Name (see below for full list) or Physician Name you are referring to
  5. Insurance Information for Patient
  6. Authorization (when required)

Fax Referral Management Process

  • When received, your fax is stored on a secure server as a PDF.
  • A fax-confirmation reply is sent thanking you for the referral.
  • The fax-confirmation includes:
    • Patient name
    • Date of birth
    • Department referred to
    • Date and time we received your fax
  • Your referral is then routed to the appropriate department for processing.

Patient Referral FAQs

What if I need to send notes or an authorization later?

  1. Children’s requires the patient information below to relate the new documents to the original referral.
    Be sure the following information is printed legibly on the authorization or medical notes:
    1. Patient Name
    2. Birth Date
    3. Referral Department Name

  2. Fax completed forms to: 510-995-2955 or 510-995-2956

  3. We will reply with a confirmation fax.

Should urgent referrals be sent to the fax line?
No. For urgent referrals, please call the specialty department directly and have the referring physician speak to the specialist on call. Specialties such as Cardiology and Hematology/Oncology use these consults to determine how soon a patient needs to be seen.

Who makes the appointment?
While some Children’s departments contact the family to schedule an appointment, your patient’s family should call the specialty department directly. Processing the fax referral will take up to one day. Ask the family to wait one business day from referral-receipt before calling.

Who do I call with questions?
Questions about the referral management system should be directed to your physician liaison. Call Physician Liaison Services at: 510-428-3043

If you wish to confirm that a specialty department received your referral, please call:
1-800-400-7337

How do I register as a referring office?
Your physician liaison will ask for a list of the physicians and NPs that refer patients from your office, along with your office fax number, and then assign you a referral fax number. If you don’t know who your liaison is, please call Physician Liaison Services at: 510-428-3043

Do you have a Patient Appointment Information Card I can offer to my patients?
Download an Appointment Information Card to give all the referral information to your patient.



2013 Referral Directory (print version available) Call: 510-428-3043


Physician Helpline: Quality Department
Email: PhysicianHelpline@mail.cho.org
Phone: 510-428-3828

DEPARTMENT

PHONE

CONTACT

EMAIL

Adolescent Medicine

(510) 428-3885 ext. 2742

Barbara Staggers. MD

Bstaggers@mail.cho.org

Anesthesiology

(510) 428-3070

Amit Gupta, MD

Agupta@mail.cho.org

Audiology

(510) 428-3344

Kelly Tremmwel-Howel, CCC-A, AuD

ktremmwellhowell@mail.cho.org

Blood and Marrow
Transplant Program

(510) 428-3374

Mark Walters, MD

Mwalters@mail.cho.org

Cardiology

(510) 428-3380

Olaf Reinhartz, MD

Oreinhartz@mail.cho.org

Cardiothoracic Surgery

(510) 428-3294

Olaf Reinhartz, MD

Oreinhartz@mail.cho.org

Center For Child Protection

(510) 428-3759

James Crawford, MD

Jcrawford@mail.cho.org

Center For the Vulnerable Child

(510) 428-3148

Diana Kronstadt, EdD

Dkronstadt@mail.cho.org

Clinical Nutrition

(510) 428-3885 ext.2008

Karen Amorde-Spalding MS,RD, CSP

Kspalding@mail.cho.org

Cord Blood Program

(510) 428-3374

Mark Walters, MD

Mwalters@mail.cho.org

Cranofacial Center

(510) 428-3885 ext. 4891

Bryant Toth, MD,

btoth@mail.cho.org

Critical Care Services/
Intensive Care Unit

(510) 428-3719

Sharon Williams, MD

swilliams@mail.cho.org

Day Hospital

(510) 428-3372

James Feusner, MD

Jfeusner@mail.cho.org

Developmental and
Behavioral Pediatrics

(510) 428-3385 ext. 5126

Lane Tanner, MD

Ltanner@mail.cho.org

Diagnostic Imaging

(510) 428-3885 ext. 2599

Ronald A. Cohen, MD

Rcohen@mail.cho.org

Early Childhood Mental
Health Program

(510) 428-3885 ext. 5126

Lane Tanner, MD

Ltanner@mail.cho.org

Emergency Department

(510) 428-3259

Augusta Saulys, MD

Asaulys@mail.cho.org

Emergency Department 2

(510) 428-3259

Augusta Saulys, MD

Asaulys@mail.cho.org

Endocrinology/Diabetes

(510) 428-3654

Jenny Olson, MD

Jeolson@mail.cho.org

Family Outreach Support Clinic

(510) 428-3129

Patricia Chase, MD

Pchase@mail.cho.org

Gastroenterology/
Hepatology/Nutrition

(510) 428-3885 ext. 2012

Elizabeth Gleghorn, MD

Egleghorn@mail.cho.org

Hand and Microsurgery

(510) 428-3024
Chau Tai, MD dr.Ctai@gmail.com

Hematology/Oncology

(510) 428-3651

Elliott Vichinsky, MD

Evichinsky@mail.cho.org

Hospitalist

(510) 428-3237

Ted Chaconas, MD

Tchaconas@mail.cho.org

Infectious Diseases

(510) 428-3336

Ann Petru, MD

APetru@mail.cho.org

International Adoption Clinic at Children's Hospital & Research Center Oakland

(510) 428-3010

Nancy Curtis, MD

Ncurtis@mail.cho.org

Medical Genetics

(510) 428-3885 ext. 2355

John Waterson, PhD, MD

Jwaterson@mail.cho.org

Neonatology/
Intensive Care

(510) 428-3276

Art D'harlingue, MD

Adharlingue@mail.cho.org

Neonatal Follow-up Program

(510) 428-3885 ext. 2299

Veronica Daly, MD

Vdaly@mail.cho.org

Nephrology

(510) 428-3335

Barbara Botelho, MD

Bbotelho@mail.cho.org

Neurology

(510) 428-3885 ext. 2912

Daniel Birnbaum, MD

Dbirnbaum@mail.cho.org

Neuropsychology Assessment

(510) 428-3885 ext. 2912

Daniel Birnbaum, MD

Dbirnbaum@mail.cho.org

Neurosurgery

(510) 428-3319

Peter Sun, MD

Psun@mail.cho.org

Ophthalmology

(510) 428-3050

Selim T. Koseoglu, MD

Skoseoglu@mail.cho.org

Orthopaedics

(510) 428-3238

Colleen Sabatini, MD

Csabatini@mail.cho.org

Otorhinolaryngology

(510) 428-3456

Robert Wesman, MD

Rwesman@mail.cho.org

Pathology & Clinical Lab Medicine

(510) 428-3530

Jon M. Rowland, MD, PhD

Jrowland@mail.cho.org

Plastic Surgery

(510) 428-3024

Chau Tai, MD

dr.Ctai@mail.cho.org

Primary Care Center

(510) 428-3129

Patricia Chase, MD

Pchase@mail.cho.org

Psychiatry

(510) 428-3354

Andrew Giammona, MD

Agiammona@mail.cho.org

Pulmonary Medicine

(510) 428-3305

Karen Hardy, MD

Khardy@mail.cho.org

Rehabilitation Medicine

(510) 428-3655

Christine Aguilar, MD

Caguilar@mail.cho.org

Sleep lab

(510) 428-3305

Karen Hardy, MD

Khardy@mail.cho.org

Surgery

(510) 428-3022

Wolfgang Stehr, MD

Wstehr@mail.cho.org

Synagis Clinic

(510) 428-3885, ext. 2914

Karen Webb, NP

Kwebb@mail.cho.org

Trauma Center

(510) 428-3022

Christopher Newton, MD, FACS

Cnewton@mail.cho.org

Urgent Care

(510) 428-3259

Augusta Saulys, MD

Asaulys@mail.cho.org

Urology

(510) 848-1727

Laurence Baskin, MD

Lbaskin@mail.cho.org

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