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Consult Request Guidelines
for Heartburn in patients younger than 50 years

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Heartburn in patients younger than 50 years
Suggested Pre-Referral Evaluation and Management Guidelines
1) Blood survey, complete blood count (CBC)
2) Anti-reflux lifestyle measures
3) Trial of OTC proton pump inhibitor or H2 blocker
Suggested Additional Test/Management Prior to Specialty Visit Assess for alarm Symptoms; if present, order EGD
Direct Access Endoscopy Referral form
Patient Education/Information (includes preps) Gastroesophageal Reflux Disease (GERD) Clinical Care Guideline
Gastroesophageal Reflux Disease (GERD)
Appointment Timeframe 1 month
How to Get Results to Consultant UMHS Patients: See MiChart
External Patients: Hand carry non-UM records and CT /MRI films to visit; outside physician offices fax records

Outpatient Consult Request Form
Clinic Contact Information Physicians: 800-962-3555
Patients: 734-647-5944 or 800-229-7408
Clinic Location Sites GI Clinic Locations
UM Consulting Physician GI Faculty

Suzanne Taylor, RN - UMHS Patient Liaison will answer provider questions.
Revised on: 05/25/2017

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