Healthcare Professionals

Refer a Patient

How to Refer a Patient

For Urgent or Same-Day Admissions

Call the Admission & Transfer Center at 513-636-XFER (9337).

For Routine Outpatient Appointments

Download and complete the Specialty Services Form. For assistance with the form, please call 513-803-0000.

Referral Forms

Outpatient Referral Forms

• Specialty Services Form / Patient Scheduling Pad
• Radiology Services Order Form (includes 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
• Clinical Laboratory Order Form
  •  COVID-19 Patient Testing Requisition
  • Allergens IgE Test Requisition
• Home Health Care Phototherapy Orders

Other Referral Forms

• Cincinnati Fetal Care Center Online Referral Form
• ED Referral Form
• ED Referral Guidelines
• Interventional Radiology Referral Form
• NCA Follow-Up Referral Form
• Pre-Procedure Physical Exam Form 

Release of Information Forms

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