Criteria

• Patients must be referred by a physician (i.e., self-referrals not accepted)

• Patients must have had an extensive evaluation that did not result in a diagnosis

• Condition prompting referral must be significant in terms of organ dysfunction, constitutional symptoms, or loss of function

• Patients must be clinically stable (i.e., not in need of emergent evaluation and care)

• The duration of the condition must be six months or longer

• Our medical staff, upon evaluation of the patient’s status, determine that our resources and expertise offer the opportunity to reach a diagnosis, beyond what has already been done

Elements necessary for referral

• Fill out this referral form

• Copy of office/clinic visit note from the referring physician which includes a recent physical exam with vital signs

• List of current medications and drug allergies

• Patient’s contact and insurance information

• For pediatric patients, please supply height/weight/head circumference growth curves and information regarding the gestational, birth, and family history

Once the above elements are received, a letter of acknowledgement will be sent to the referring physician, including a request for missing elements, if applicable. If the patient is to be evaluated in the UDP, the referring physician and patient will be notified. At that time, further documents will be requested as needed. The expectation is that the patient will be evaluated in the outpatient setting; should the patient require extensive and/or additional invasive testing that cannot be performed as an outpatient, hospital admission will be arranged. If the patient will not be evaluated in the UDP, the referring physician will be notified and alternative clinics at UAB will be proposed, if appropriate. If the patient has provided history by telephone to our clinical coordinator, and the determination is made that the patient will not be evaluated, the patient will be notified by telephone. The estimated time from receipt of the referral to the determination for evaluation in the UDP is six to eight weeks.

The UDP should not be envisioned as a referral site due to lack of availability of basic diagnostic or evaluation resources to the referring physician. Similarly, the UDP should not be seen as a place for referral of patients who are acutely ill and/or unstable who require intense management in the acute setting or have already diagnosed and managed complex medical conditions. Upon diagnosis, the patient will receive management and treatment recommendations, to be coordinated in our facility and/or per the patient’s local care providers, according to the needs of and resources available to each patient. The UDP does not provide ongoing care for the patient’s condition(s). Questions regarding the referral process can be directed to Tammi Skelton, clinical coordinator (205.996.6583).

Referral documents containing the above elements, if less than 30 pages, may be faxed to: 205.934.4111 (attention: UDP). Otherwise, please mail documents to:

UAB, Kaul 230
1720 Second Avenue South
Birmingham, AL 35294-0024
Attention: UDP

The Physician's Summary of Present Illness can be submitted online.