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Appropriate patients for referral:
- Patients with refractory asthma having difficulty controlling symptoms despite appropriate treatment
- Patients needing evaluation of their current asthma management plan
- Patients with recent ED visit or hospitalization for asthma
- Patients with chronic urticaria
- Patients with immunodeficiency
- Patients with chronic sinusitis
- Patients needing skin testing for allergen avoidance counseling
Documentation required for scheduling an appointment:
- Completed Referral form
- Past Medical History (PMH)
- Current medication list
- Most recent progress note describing condition for which patient is being referred.
- If reports are available, include with referral. If patient has not had testing, reports are not required for scheduling appointment.
Examples of report: chest films, pulmonary function testing, labs, skin testing results.
Revised May 2015
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