At Phoenix Children's, we strive to make access to our network easier and to promote collaboration between clinicians to provide the best healthcare for our patients. Whether it's offering continuing medical education or continually expanding our medical information resources for providers, we are committed to providing ongoing professional education opportunities that enhance and advance the delivery and quality of care for patients.
Patient Referrals
We provide three options, depending on the patient’s needs and urgency of the referral.
Professional Education Opportunities
Phoenix Children's Care Network (PCCN)
Phoenix Children’s Care Network (PCCN) is a physician-led, pediatric-focused clinically integrated network committed to delivering high-quality, coordinated, cost-effective pediatric care.
To Request a Test or Service for Your Patient
Please find the order/request form for the particular test or service you need below, along with directions for how to submit it. For all orders and requests, please include:
- Date of order
- Your patient’s demographic information
- Name and electronic signature of the requesting primary care physician
Note: If your patient needs a service related to Dermatology, Endocrinology or Gynecology, please visit the e-Consult page. We schedule these appointments via e-Consults.
Our pediatric audiologists offer hearing tests and diagnoses for your patients, along with the latest care recommendations. We provide:
- Newborn hearing screenings
- Diagnostic audiologic evaluations
- Auditory evoked potential (AEP) evaluations
- Hearing aid consultations with hearing evaluations
- Cochlear implant services
- Auditory processing disorder (APD) evaluations
- Custom ear molds
- Other specific audiology procedures
To request an audiology service for your pediatric patient, submit a referral through your EMR or you may use the Audiology Order Form below:
Audiology Order Form – PCH 10531
To submit the Audiology Order Form:
Please send via fax to 602-933-2470.
If you have questions, please contact 602-933-0905.
Psychology
If your patient is between the age of 4 years and 6 years, 11 months old:
Our pediatric psychologists complete an autism evaluation for children in this age range. (Please note that this evaluation is only for children with co-occurring complex medical needs or genetic differences. We will refer all other patients to community services.)
To request an autism evaluation for your pediatric patient with co-occurring complex medical needs or genetic differences, please submit a referral to On Demand Booking. When received you will be sent the following form to complete online.
Autism Diagnostic Evaluation Form – PCH 12112
We realize that you may have patients without complex medical needs who require autism evaluations. Please direct these patients to a list of community resources and autism testing locations. You’ll find this list at the bottom of our Autism Program page, under Patient Resources.
In our Center for Fetal and Neonatal Care, we support expectant mothers by providing expert prenatal care for their unborn babies. We also work to give premature babies and at-risk newborns a healthy start to life.
To request a fetal care center referral or a fetal care echocardiogram for your maternal-fetal medicine patient:
Please download, complete and submit the Fetal Care Referral/Order Form below. Include patient demographics, ultrasound reports, relevant records and any fetal genetic studies.
Fetal Care Referral Order – PCH 11846
To submit your patient’s Fetal Care Referral/Order Form:
Please send via fax to 602-933-4268.
When your order is received and accepted, you or your patient may call 602-933-4411 to schedule an appointment. If you have questions, please call 602-933-4411.
To request services from our Newborn Early Screening Team (NEST) and Neonatal Intensive Care Unit (NICU):
Please download, complete and submit the NEST/NICU Follow-up Clinic Referral Form below. Please include patient demographics, relevant information and records.
NEST Referral Order Form – PCH 11928
To submit your patient’s NEST/NICU Follow-up Clinic Referral Form:
Please send via fax to 602-933-2436.
When your order is received and accepted, you or your patient’s family may contact our Center for Fetal and Neonatal Care at 602-933-4411 to schedule an appointment. If you have questions, please call 602-933-4411.
Our pediatric occupational therapists provide comprehensive services for babies and children with congenital conditions or acquired illnesses and injuries. To order OT services for your pediatric patient, submit a referral through your EMR or you may use the Occupational Therapy/Order Form below:
To submit the Occupational Therapy Referral/Order Form:
Please send via fax to 602-933-2465.
When your order is received and accepted, you or your patient’s family may contact Occupational Therapy at 602-933-0980 to schedule an appointment. If you have questions, please call 602-933-0980.
Our pediatric physical therapists can help your patient achieve the highest possible level of muscle strength, function and independence. We treat children with all types of congenital and acquired conditions, developmental issues and injuries. To order PT services for your pediatric patient, submit a referral through your EMR or you may use the Therapy Referral/Order Form below:
To submit the Physical Therapy Referral/Order Form:
Please send via fax to 602-933-2465.
When your order is received and accepted, you or your patient’s family may contact Physical Therapy at 602-933-0980 to schedule an appointment. If you have questions, please call 602-933-0980.
Our expert sleep medicine team is specially trained to manage and treat sleep disorders in children.
To order a sleep lab study for your pediatric patient, please download, complete and submit the Sleep Lab Physician Referral/Order Form below:
Sleep Lab Referral Form – PCH 11383
On this form, be sure to indicate the appropriate Current Procedural Terminology (CPT) codes.
If your patient is less than 6 years old, check these codes on the form:
- 95782 Polysomnography
- 95783 CPAP
If your patient is greater than 6 years old, check these codes on the form:
- 95810 Polysomnography
- 95811 CPAP
Please include notes from the office visit in which the physician requested the sleep study to be performed. (This information will help us when performing the insurance verification.) Also, please list at least one or two working phone numbers that we can use to reach your patient’s family.
To submit the Sleep Lab Physician Order/Referral Form:
Please send via fax to 602-933-2447.
When your order is received and accepted, you or your patient’s family may contact our sleep lab at 602-933-1118 or 602-933-2629 to schedule an appointment. If you have questions, please call 602-933-1642.
Using the laboratory sweat chloride test, we examine the movement of sodium and chloride through the patient’s exocrine glands. The sweat test is the gold standard diagnostic test for cystic fibrosis. People with cystic fibrosis have higher chloride levels in their sweat. Providers often order the sweat chloride test for patients with:
- Recurrent respiratory symptoms
- Recurrent pneumonia
- Growth failure
- Chronic constipation
- Nasal or sinus polyposis
- Rectal prolapse
- Chronic diarrhea
- Failure to thrive
To order a laboratory sweat chloride test for your pediatric patient, please download, complete and submit the Laboratory Sweat Chloride Test Request Referral Form.
Please note the sweat test is contraindicated for:
- Patients with an implanted device, such as a defibrillator, neurostimulator, pacemaker or ECG monitor
- Patients with a history of epilepsy or seizures
- Patients who are pregnant
- Patients who have a known sensitivity or allergy to any ingredient used for this testing
- Patients with damaged, denuded skin or recent scar tissue
- Patients with cardiac conditions or with suspected heart problems
To submit the Laboratory Sweat Chloride Test Request /Referral Form:
Please send this form via fax to 602-933-0327.
When your order is received and accepted, you or your patient’s family may contact our laboratory at 602-933-0314 to make an appointment. If you have questions, please call 602-933-0314.