Camh referral fax 2025

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  1. Click ‘Get Form’ to open the camh referral fax in the editor.
  2. Begin by entering the 'Date of Referral' at the top of the form. This is essential for tracking your submission.
  3. Fill in the 'Referring Site' and 'Primary Care Provider Name' fields. Ensure that you provide accurate contact information, including 'Phone Number' and 'E-Mail'.
  4. If known, specify the 'Client Preferred OTN Site' and complete the details for the 'OTN Site Name', 'OTN System Number', and 'OTN Site Coordinator'.
  5. Indicate availability for both the client and OTN site in the designated sections, ensuring to note any time constraints.
  6. Review the inclusion and exclusion criteria carefully to confirm eligibility before submitting.
  7. Attach any required documents such as medical reports or scales mentioned in the instructions before finalizing your submission.

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FAX the completed form and a copy of your ID to the Medical Records Department at (855) 874-5286 or email the Medical Records Department. Please allow up to 15 business days to process medical records requests.
UCLA Health will always be a students most affordable option when seeking services outside of The Ashe Center. After an Ashe Center referral is obtained, students can call the UCLA Physician Referral Service (P: 310-825-263) for fast, easy access to the physicians and services at UCLA Health.
Submit patient referrals by fax to the Physician Referral Services fax number: (310) 301-5391.

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Temple University Hospital Patients Phone: 215-707-3755. Fax: 215-707-6123.

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