REFER A PATIENT | Infectious Disease

Referring a Patient

Referring a patient to NWSMA is simple.

Our office is a referral based office. We are happy to provide infectious disease care for your patient.

To refer your patient, complete the form below and provide the required information listed below.

In order to expedite processing of your patient's referral, please ensure the form is completed and all required information and records are included.

Required items:

Patient demographics
Patient insurance information
Confirmed diagnosis/reason for referral
All office notes relating to diagnosis
All labs/cultures relating to diagnosis
All radiology reports relating to diagnosis
Any other pertinent information regarding patient's care

If you feel your patient will require an urgent appointment, please call our office at 847-255-5030 and speak with our intake team directly.

After all information is received, our intake team will triage each referral and schedule appointments according to urgency. We will call the patient directly to schedule.

Submitting A Referral

Is as easy as 1...2...3...

1

Download our physician referral form.

Referal Request Form

2

3

Fax: 847/255-0156

referral form, demographics, pertinent patient information and records.

If you feel your patient requires an urgent appointment, please complete steps 1-3 AND

Call: 847/255-5030

and speak with our intake team.

Make sure all

required information and documentation are attached.

Please note: incomplete referrals will delay the scheduling process.