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For Referring Physicians

Please fax the following documents to (585) 341-8453 prior to the patient's visit. Each sheet should be labeled with the patient’s name and date of birth.

  • Contact telephone number/pager for your office – it is important that our providers be able to contact you for consultation if any medical needs for your patients arise while they are under our care.
  • Copy of patient’s demographics.
  • Most recent Clinical Summary – within 30 days.
  • Most recent Clinical Summary within 60 days for nursing home patients.
  • Most recent Laboratory results – within last 7 days.
  • Physician’s order form signed and dated by physician/nurse practitioner/physician assistant, including any additional medication orders needed to care for your patient during their stay.
  • Current medication list.
  • Consent for blood transfusion signed and dated by MD/NP/PA , and patient or patient guardian. If phone consent is completed with patient, please write “phone consent obtained” on consent form underneath patient’s signature line.

Forms