Office: (361) 694-5057
Fax: (361) 808-2067
Fax information required by referring physician:
- DCH patient referral form (script signed by PCP)
- Insurance/Medicaid card (front and back)
- Authorization/referral number, number of visits
- Script with diagnosis/reason for referral and doctor’s signature
- X-ray and/or lab studies or notation stating studies done at DCH. If study done outside of DCH, please bring actual films or image CD.
- Progress notes (Notes from PCP, other specialist, previous surgeries or procedures, Etc.)
Note: The DCH Orthopedic Clinic staff will contact the referring physician’s office after all information is received and reviewed.
Patient must bring to appointment:
- Patient must be accompanied by parent/guardian (with ID) who knows the history
- Immunization card
- List of current medications