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 David Lawrence Brown MD
Paul Stephen Cederna MD
Robert Harris Gilman MD
Steven Carl Haase MD
Jeffrey Hall Kozlow MD
William Michael Kuzon Jr MD
Adeyiza Olutoyin Momoh MD
Edwin Grant Wilkins MD
Revised on: 03/24/2014



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