Option 1: (no Electronic Medical Record) fill out all information on this PDF form, then submit the completed form via email or via fax to 720.848.1651.
Option 2: (Electronic Medical Record on hand): From the EMR, you may send signed physician orders with ALL supporting clinical documentation/records (REQUIRED), especially if UCHealth is attempting to obtain authorization for you. This may include current progress notes, imaging reports, or any other relevant documentation.
Send this information via email or via fax to 720.848.1651. Please be sure to include updated patient demographics, including phone number, address, and updated copy of insurance card.
