Ohsu clinic referral form 2026

1. Click ‘Get Form’ to open the OHSU clinic referral form in the editor.
2. Begin by filling out the 'PCP Information' section. Enter the name of the primary care provider, along with the referral coordinator's name, phone number, and fax number.
3. If applicable, complete the 'Referring Provider' section with the provider's name, specialty, phone number, and fax number.
4. In the 'Patient Demographics' section, provide the patient's full name, date of birth, address, city/state/zip code, and contact numbers. Circle the best contact number if known.
5. Fill in the 'Insurance Information' with details such as company name, policy holder's name, policy ID number, group number, and insurance phone number.
6. Clearly state the reason for referral and list any medical problems or current medications. Include any adverse reactions and history of suicidal or homicidal ideation if relevant.
7. Finally, add any additional comments and review all sections for completeness before submitting.

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