Transfers, referrals and more

Radiology/imaging requests and referrals

  • Option one (no Electronic Medical Record): read all information on this PDF form, then submit the completed form via email or via fax to 720-848-1651.
  • Option two (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.