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Ohsu clinic referral form 2026

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  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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OHSU includes two hospitals (OHSU Hospital and OHSU Doernbecher Childrens Hospital) and numerous medical practices that are located on Marquam Hill, at the Center for Health Healing, at the South Waterfront and in several neighborhoods in the Portland metro area.
A patient referral form is a document that is used by medical professionals in order to refer a patient to another doctor. This document can be used for any type of medical practitioner to refer patients to another specialist or doctor. Just customize the questions to match how you want to manage patient referrals.
For help with a referral, call our Physician Advice and Referral Service at 503-494-4567 between 7 a.m. and 7 p.m.
Registration. If you are a new OHSU Health patient or your insurance has changed, please call OHSU Registration at 503-494-8505 to provide insurance information. For a hospital stay, call 503-494-8927 to answer additional questions.
The company currently operates 188 offices in 29 markets. The companys concierge model now supports all ages, too. In June, One Medical acquired Iora Health, another primary care competitor focused on Medicare patients, in a $2.1 billion deal.

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U.S. News evaluated 64 hospitals in Oregon. Eight meet high U.S. News standards and are recognized as Best Regional Hospitals. U.S. News also ranked hospitals in the Portland metro area. The number 1 hospital in Oregon is OHSU Hospital.

Related links

How to Submit Prior Authorization Requests to OHA

Information to help Oregon Health Plan providers submit fee-for-service prior authorization requests to the Oregon Health Authority.

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OHSU patient referrals

You can fax your own referral form or one of ours, along with patient records, to 503-346-6854. OHSU forms: Adult referral form Pediatric referral formRead more

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21st century medicine:

The document you are about to read emerged from a systematic process of inquiry and intentionality about some of the most critical issues in health care.Read more

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