Attach a copy of the patients insurance card and authorization form. We value and embrace diversity and are proud to offer a welcoming environment and culturally. If you would like to refer a patient with a condition which is not. Online forms informed consent, davis oral and maxillofacial. Uc davis medical group offers nationally renowned primary and specialty care at uc davis medical center and offices across the sacramento region. If you would like to refer a patient with a condition that is not listed below, please send your request along with the. The university of california, davis, and the department of environmental science and policy are interested in candidates who are committed to the highest standards of scholarship and professional activities, and to the development of a campus climate that supports equality and diversity. Please complete the form and fax it to our referral coordinators at 19167345194. Uc health plans will be open for enrollment from 8 a. The 30 second elevator speech university of california. Contract terms and conditions uc davis student housing. The health information management department strives to achieve the highest level of customer satisfaction by providing a well documented, accurate, timely record of medical care for continuing patient care, research, teaching and community service. Unraveling the mysteries of vision uc davis eye center.
Uc davis conducts more than 1,000 research studies. University of california, davis health system university of california, irvine the following is a listing of clinical conditions appropriate for telemedicine pediatric neurology consultation. Finding a specialist, physicianconnect, referral process. We would appreciate it if your staff could fax the records along with the referral form. Requested specialty and name of uc davis provider if known. Sponsored programs office university of california, davis subaward request form page 1 of 2 spo 122018 complete and submit this form along with the required documents specified under directions below to. For specialties not listed, please provide as much documentation as possible to assist us in securing a onetime consultation. We provide a comprehensive multidisciplinary approach to all patients and take pride in our innovative care and excellent outcomes. If an shcs provider determines that a student needs further care that cannot be provided by shcs, a referral will be provided. We process stat access requests within 30 minutes during business hours. We emphasize wellness, apply the latest knowledge to solve health problems, and offer access to new therapies and advanced technologies when needed. Personnel policies for staff members ppsm human resources. Again, we thank you for being a partner with us in the education of your future colleagues. I authorize university of california davis student housing to discuss my accommodations with applicable.
To make the most of the evaluation visit, our physicians have asked that we obtain the following records in advance of the visit. Physicianconnect is a dynamic tool that offers secure online access to patient medical records, giving you the ability to stay informed at all times and every step of the treatment or referral process. Himss analytics stage 7 hospitals are considered to be completely paperless. Please provide the following information in order to help us schedule a consultation appointment. Physicianconnect customer service at uc davis health. Referring physicians and their patients have access to a full array of ophthalmic clinical services and educational resources founded on the latest. Yes, you will need a referral from your veterinarian. Internal fellowships are funds controlled by uc davis.
Referral intake form indicates required field referral date. What information do i need when making an appointment. Clinical trials uc davis conducts more than 1,000 research studies annually with the goal. School of veterinary medicine referring veterinarians uc davis.
If you have any questions about these resources or need more information, please. This is a confidential fax and is intended solely for the person indicated above. Upon obtaining an account, you will have viewonly access to the records of your patients who have been seen at uc davis. Provide the student a space in an apartment leased by uc davis. It communicates who you are, what youre looking for and how you can benefit a company or organization. To begin the referral process, please complete our referral intake form online and fax it to.
We appreciate the opportunity to partner with you in your patients care. For referring physicians uc davis eye center uc davis health. Prior to submitting a referral, please complete the following. To initiate a referral on behalf of your patient, please click the button below to submit an electronic referral form or download and complete our referral request. Complete a telehealth referral request form fax the form to 866 6225944 or submit via email along with any documentation outlined in the referral guidelines.
Essential layoff resources for employees human resources. If you are not the intended person, you are hereby. Complete a telehealth referral request form fax the form to 866. Find forms and information on how to request medical records from the health information. Providing you with online forms for informed consent, patient health history, financial policy, patient registration, and more for davis oral and maxillofacial surgery, davis ca oral surgery, if you have questions please call 5307530550. Cdi and midtx forms pcit university of california, davis. You must get an shc referral for care outside the shc, regardless of the distance from campus, except for the. Uc davis medical center serves the healthcare needs of the sacramento metropolitan area, and is a referral center for patients throughout northern california and nevada. New patient referrals uc davis health system transplant center. Orthopedic surgery service school of veterinary medicine. Only those medical services received on the basis of an shcs physician referral will be considered for payment by uc ship. The mission of student health and counseling services is to enhance the physical and mental health of students in order to help them achieve academic success, personal development and lifelong wellness by providing an integrated program of quality, accessible, cost sensitive and confidential healthcare services, tailored to their unique and diverse needs and to assist the university community. All referrals to the neurological surgery clinic require a referral from the patients primary care physician pcp or any treating physician to the physicians referral center at 18004ucdavis 4823284.
Stay connected with whats happening at uc davis health. Refer a patient uc davis center for health and technology. Authorization information with cpt code details and approved visits please fax all of documents to the physician referral center at 9167036048. Uc davis conducts more than 1,000 research studies annually with the goal of bringing new, effective. The uc davis diagnostic radiology residency program is located at the uc davis medical center in sacramento, the major teaching facility of the uc davis school of medicine. Be entitled to transfer student apartment occupancy only while a registered student at the university of california, davis. Submit an electronic referral form or use our referral request kit pdf. Uc davis irb administration is transitioning to a new online form for use after the initial approval of research. New patient referrals uc davis health system transplant.
Please submit the following with your referral request. Parent certification form will be emailed to parents once supplemental application is complete. To make the most of the evaluation visit, our physicians have asked that we obtain the following. Please have a look at the uc davis privacy policy for more information on how we use your data.
The 30 second elevator speech university of california, davis. Please note that if this information is not provided, there will be a delay in scheduling your patient. Below are links to online forms and collections of downloadable forms offered by various campus departments and colleges. If you need to create a referral on a patient who is new to ucd, please contact the referral center at 8004ucdavis 8004823284 or click here to begin the referral process. Requested specialty and name of uc davis provider if known specialty. Attach the completed medicare secondary payer questionnaire mspq form if necessary. If you are unsure of which form to complete, please start by using the contact an expert feature on this site. Information for veterinarians cardiology referral form information.
School of veterinary medicine information for veterinarians. Parent certification form will be emailed to parents once supplemental application is complete parents of medical students 20192020 academic year july 1, 2019 to june 30, 2020 supplemental application pdf all students parent certification form pdf parents of medical students. Attach all pertinent medical records as specified in the referral guidelines. Dentistry and oral surgery service form uc davis school of. The university of california, davis is committed to creating a healthy and supportive environment for each employee and administering all policies fairly and equitably.
All referrals to the neurological surgery clinic require a referral from the patients primary care physician pcp or any treating physician to the physicians referral center at 18004uc davis 4823284. Consultation instructions we will provide instructions on how to connect for your. Referral request form university of california, davis. Uc davis health clinical telehealth program referral. The university, at its sole discretion, reserves the right to utilize single rooms and studio apartments for double occupancy and, if such occurs, the student shall be charged a lower room rate as determined by the university. Uc davis will use your personal data to help provide a better website experience and to support other uc davis communications. New patient referrals thank you for your interest in the uc davis transplant center. Submit the completed form to the uc davis student housing office. The mission of the university of california, davis, health system eye center is to provide the highest possible quality of patient care, to conduct pioneering research on the visual system and its disorders, and to train residents, medical students, practicing physicians, allied health personnel, and fellows for outstanding careers in. Clinical trials uc davis conducts more than 1,000 research studies annually with the goal of bringing new, effective and safe treatments more quickly. Complete this referral form in its entirety and submit prior to scheduling.
Physicianconnect is a webbased version of the uc davis electronic medical record system. The advantage referral program, which allowed for specialty selfreferrals across medical groups, has. Graduate student orientation university of california. Confirmation call a telehealth coordinator will call you to schedule your appointment. Completed uc davis referral intake form included in the referral request kit. Diagnostic radiology residency program uc davis department. Personnel policies for staff members ppsm read more about ppsm ppsm applies to professional and support staff, managers and senior professionals, and senior management group employees. Confirm patient name and name on insurance cards obtain copy of most uptodate insurance cards important.
Uc davis health clinical telehealth program referral guidelines pediatric cleft and craniofacial clinical telehealth consultations comprehensive facial plastic surgery and pediatric otolaryngology care of children with orofacial clefts and microtia. An elevator speech is a clear, brief message or commercial about you. Everify ucd campus procedure university of california. Visual or hearing impairment mobility impairment chronic medical condition mental health condition food allergies or medical dietary restriction. For access to a new patient you may send us an inbasket message through physicianconnect, email us or fax the request to us.
You need a referral for care outside the shc i have my referral. Uc ship medicalmental health benefits uc davis shcs. Referral intake form please fax this completed form and checklist items to 9167036048. Dentistry and oral surgery service form uc davis school. Complete a room condition form at beginning of occupancy and submit the form by the assigned deadline. Its typically about 30 seconds, the time it takes people to ride from the top to the bottom of a building in an elevator. Students receive primary care at uc davis student health and counseling services shcs. University of california, davis health system university.
This form is for use by incoming or current residents who have a diagnosed and documented disability. The physicians referral center enters all uc davis specialty clinic referrals into the uc davis referral database for processing. Dentistry and oral surgery service form thank you for referring your client and patient to the uc davis vmth dentistry and oral surgery service. Ppsm contains information specific to nonrepresented staff employees, with some content applicable to represented employees, such as leave and supplemental military leave. New form pdi readiness checklist 3817 training and self monitoring tool.