Referral Process and Forms

MDPortal referrals

• Submit directly to our MDPortal at mdportal.stanfordchildrens.org

All other outpatient referrals

Submit directly online with our new General Outpatient Referral Request Digital Form

1. Attach and upload relevant notes
2. Include a copy of the patient’s insurance card
3. Authorization for Treatment (if required by insurance provider)

Outpatient specialty referrals

We launched digital versions of a few forms, streamlining your referral process.

By submitting the form electronically directly from your computer, or from a mobile device, we have eliminated the need to fax. You have the ability to attach relevant clinical documents, authorizations and insurance cards, with the option to upload up to 30 files. 

We will add many new digital forms over the coming weeks. 

• General Outpatient Referral Request Digital Form
  
• Audiology Digital Referral Form
• Cardiovascular Connective Tissue Disorders Digital Referral Form
• Center for Healthy Weight Digital Referral Form (Please include growth chart)
• Developmental-Behavioral Pediatrics Digital Referral Form (Please include growth chart)
• Eating Disorders Digital Referral Form
• Genetics Digital Referral Form (Please include growth chart)
• Motion Analysis and Sports Performance Laboratory Digital Referral Form
• Motion & Gait Digital Referral Form
• Neurology Digital Referral Form
• Pain Management Digital Referral Form
• Perinatal Diagnostic Center (PDC) Digital Referral Form
• Pulmonary Clinic Digital Referral Form
• Sleep Center's Referral Request Digital Form

The following services require specific referral forms and/or clinical notes:

• Center for Fetal and Maternal Health, referring physician orders
• ECG, Echo, Holter monitor or event request recorder
• EEG - outpatient referral form
• Endocrinology, Please include pertinent labs, growth chart and notes from last 3 visits.
• Exercise Laboratory orders form
• Fetal Echocardiogram orders form
• Hematology, Please make direct referral by calling (650) 497-8953.
• Infectious Disease, Please include immunization records.
• Interventional Radiology
• Nephrology, Please include pertinent labs.
• Neuro-Oncology, Please make direct referral by calling (650) 497-8953.
• Neurosurgery, Please include pertinent labs, MRIs and/or CTs
• Nuclear Medicine referral request form
• Oncology,  Please make direct referral by calling (650) 497-8953.
• Radiology requisition form        
• Urology, Please include pertinent labs and radiology reports