• DCH patient referral form (script signed by PCP)
• Insurance/Medicaid card (front and back)
• Authorization/referral number, number of visits
• Script with diagnosis/reason for referral and doctor’s signature
• X-ray and/or lab studies or notation stating studies done at DCH. If study done outside of DCH, please bring actual films or image CD.
• Progress notes (Notes from PCP, other specialist, previous surgeries or procedures, Etc.)

Note: The DCH Orthopedic Clinic staff will contact the referring physician’s office after all information is received and reviewed.