CONSULT REQUEST GUIDELINES                                                                         Print

Hemophilia & Coagulation Disorders

Suggested Pre-Referral Evaluation and Management Guidelines  
Suggested Additional Test/Management Prior to Specialty Visit Bleeding Disorders Adult
Prior to Specialty visit:
PT / PTT, repeated a second time if elevated

Bleeding Disorders Pediatrics
Prior to Specialty visit: None required

Clotting Disorders
Prior to Specialty visit: None required
Patient Education/Information (includes preps)

For patient information including pre-appointment forms, maps & directions, participating insurance plans, and support:
http://www.mcancer.org/support

Appointment Timeframe Adults - 3 to 4 months (unless urgent)
Pediatrics - 2 to 3 weeks (unless urgent)
How to Get Results to Consultant

UMHS patients: See CareWeb
External Patient - Fax to: 734-936-5953
Mail to:
UMHS - Hemophilia & Coagulation Disorders
Attention - Dianne Hatfield, Program Coordinator
1500 E. Medical Center Drive SPC 5235
Ann Arbor, MI 48109-5235

Records required:
Bleeding Disorders:
Diagnostic lab studies
Inpatient/outpatient hospital records for treatment of bleeding episodes
Dictated summary of patient's condition

Clotting Disorders:
Diagnostic Lab Studies
Only recent PT/INR
Doppler reports (no films)
CT reports if any(no films)
Inpatient/Outpatient hospital records clotting episodes (DVT, PE, Arterial clotting)
Dictated summary of patient's condition

Clinic Contact Information Physicians: 800-962-3555
Patient: New Patients: 734-936-6393
or 734-647-8901 option #3
Return Visit Patients: 734-936-6393
or 734-647-8901 option #3
FAX: 734-936-5953
Clinic Location Sites Adult Hemophilia and Coagulation Disorders
Pediatric Hemophilia and Coagulation Disorders
UM Consulting Physician Adult Hemophilia and Coagulation Disorders Faculty
Pediatric Hemophilia and Coagulation Disorders Faculty
Revised on: 09/10/2014
 
 

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