
ENT
Office: (361) 694-5778
Fax: (361) 654-0317
Fax information required by referring physician:
- DCH patient referral form (script signed by PCP)
- Insurance/Medicaid card (front and back)
- Physician’s notes
- ABR results, hearing test results, Sleep study results, Labs, X-Ray pertaining to the diagnosis (if available)
- Insurance Information, Demographics showing at least one of the parents full name & date of birth
Patient must bring to appointment:
- Patient must be accompanied by parent/guardian (with ID) who knows the history
- Guardianship paperwork/letter of medical consent (If patient is under care/custody of someone other than parent)
- Insurance/Medicaid card