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How to use or fill out chla migratedOutpatientReferralForm - Children's Hospital Los Angeles
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the date at the top of the form. This is essential for tracking your referral.
- In Section I, provide your information as the referring physician. Fill in your first and last name, office address, phone number, fax number, and email address. If there is a contact person other than yourself, include their name.
- Move to Section II to input patient and family information. Enter the patient's first and last name, date of birth, gender, primary language, and guardian details including their names and contact information.
- In Section III, indicate whether the referral is urgent or routine. Specify the requested specialty or specialist along with the reason for referral/diagnosis and preferred location from the options provided.
- Finally, complete Section IV by selecting the patient’s insurance type and providing necessary details such as insurance carrier and subscriber ID. Ensure you attach any required prior authorization documentation if applicable.
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What is the mission of CHLA?
At Childrens Hospital Los Angeles our mission is to Create Hope and Build Healthier Futures. As a leading academic childrens hospital, we fulfill our mission by caring for children, adolescents, young adults, and families, advancing knowledge, and preparing future health care providers.
What type of hospital is CHLA?
CHLA Is a Premier Childrens Hospital We believe every child deserves the best care possible. This is why were building a network of people and places across Southern Californiaso more children can get the care they deserve in more than 350 specialty programs and services.
What is the purpose of CHLA?
CHLA Is a Premier Childrens Hospital We believe every child deserves the best care possible. This is why were building a network of people and places across Southern Californiaso more children can get the care they deserve in more than 350 specialty programs and services.
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People also ask
How many beds is CHLA PICU?
The 24-bed Pediatric Intensive Care Unit (PICU) is the largest such unit on the West Coast.
How many active beds does CHLA have?
Identification and Characteristics Name and Address:Childrens Hospital Los Angeles 4650 Sunset Boulevard Los Angeles, CA 90027CMS Certification Number :053302Type of Facility:ChildrensType of Control:Voluntary Nonprofit, OtherTotal Staffed Beds:4139 more rows
How many beds does CHLA NICU have?
The Division of Neonatology at CHLA offers an integrated team that provides compassionate, advanced, evidence-based care for critically ill newborns and infants. The Steven Alexandra Cohen Foundation NICCU is a Level IV, state-of-the-art, 58-bed unit.
How many licensed beds does CHLA have?
Childrens Hospital Los AngelesEmergency departmentlevel I pediatric trauma centerBeds495HistoryOpened190114 more rows
How many beds does childrens hospital of San Antonio have?
Identification and Characteristics Name and Address:Childrens Hospital of San Antonio 333 North Santa Rosa Avenue San Antonio, TX 78207Total Staffed Beds:174Total Patient Revenue:$1,164,777,265Total Discharges:5,158Total Patient Days:33,9859 more rows
