Healthcare Professionals

Patient Referral Information for Physicians

New to Cincinnati Children’s

If this is your first time referring a patient to Cincinnati Children’s or you have general questions, call 1-877-881-8479.

Same-Day Admissions

For urgent same-day admissions, call Physician Priority Link at 1-888-636-7997. A staff member will page the manager of Patient Services, who will handle your request.

Routine Outpatient Services

Appointments are necessary for all services except for most laboratory tests performed in the Test Referral Center. 

Referral Forms

You must have the free Adobe Reader software installed on your computer to download forms. You can download Adobe Reader at Adobe's website by selecting the version appropriate for your type of computer.

Outpatient Referral Forms

• Request for Specialty Services 
• Radiology Services Order Form (includes both Radiology and Nuclear Medicine)
• Diagnostic Testing Order Form (includes EKG, ECHO, EEG, EMG, PFT, DXA Scan, GTT and Sweat Chloride)
• Occupational Therapy / Physical Therapy / Speech Pathology / Audiology Services Order Form 

Walk-in Services

• Ancillary Order Form 

Home Care Services

To speak with someone about a referral to Home Care Services, please call our Home Health Intake line at 1-513-636-7777.

• Home Health Orders / Nurse Visits / HME Supplies
  
• OT / PT Home Health Order Form
• Speech Therapy Order Form
  
• Synagis Order Form 
• Synagis - Statement of Medical Necessity 
• Home Health Nurse Visits for Asthma 
• Phototherapy Orders 
• Home Health Supplies / Equipment Only 

Other Referral Forms

• ED Referral Form
• ED Referral Guidelines
• Interventional Radiology Referral Form 
• Pre-Procedure Physical Exam Form 
• NCA Follow-Up Referral Form

Release of Information Forms

• Confirmation of Treatment Relationship 
• Authorization for Use and / or Disclosure of PHI