| CONSULT REQUEST GUIDELINES
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Gastroesophageal Reflux Disease
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| Suggested Pre-Referral Evaluation and Management Guidelines |
1) H2 blockers
2) PPI
3) Prokinetic
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| Suggested Additional Test/Management Prior to Specialty Visit |
1) UGI
2) Ph probe (if clinically indicated)
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| Patient Education/Information (includes preps) |
1) Nissen fundoplication
2) Prep: Prep for Pediatric Upper GI
3) Prep: ph probe |
| Appointment Timeframe |
Next Available Appointment. Please complete Outpatient Consult Request Form and fax to 734-936-9784
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| How to Get Results to Consultant |
UMHS Patients: See CareWeb
External Patients: Hand carry or fax records to 734-936-9784 |
| Clinic Contact Information |
Physician: 800-962-3555
Patients: 734-764-4151 |
| Clinic Location Sites |
C.S. Mott Children's Hospital |
| UM Consulting Physician |
Pediatric Surgery Faculty
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| Revised on: |
03/22/2011 |
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