CONSULT REQUEST GUIDELINES                                                                         Print

Burn Injury Reconstruction

Suggested Pre-Referral Evaluation and Management Guidelines
1) Past medical history pertinent to condition
2) Complete surgical history
3) Past operative notes specific to condition
Suggested Additional Test/Management Prior to Specialty Visit
1) If pulmonary or cardiac history, patient must have clearance from their physician
2) If cardiac history, there must be a current EKG (within last 6 months)
3) Tobacco free for at least 2 months pre-operatively
4) All pre-operative and post-operative photos specific to condition
Patient Education/Information (includes preps) Patients must be non-smokers at the time of surgery
Appointment Timeframe Next Available
How to Get Results to Consultant UMHS Patients: See MiChart
External Patients: Outside records are preferred before appointment date. Fax To: 734-998-5621
or send to:
Dominos Farms
24 Frank Lloyd Wright Dr.
Lobby A, PO Box 441
Ann Arbor, MI 48106-5735
Clinic Contact Information Physicians: 800-962-3555
Patient: 734-998-6022
Clinic Location Sites Dominos Farms
UM Consulting Physician Plastic Surgery Physicians/Providers
Revised on: 12/19/2014



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