- Referral Form
To minimize your time on the phone, we offer an alternate means for you to provide us with information to begin the transfer process, should you feel this beneficial. You can use this form in two ways:
- You can have one of your staff call the Transfer Center to relay the information from the completed form to us.
- You can fax the completed form to the Transfer Center at 801-581-2256
In eaither case, we will contact the appropriate accepting physician and then connect them with you. Should you choose to use this option, we request you be readily available to speak to our attending physician once contact is made.
- Transfer Checklist
Please fax the top portion to the Transfer Center ASAP. This will assist us in pre-registering your patient. The checklist will assist you in gathering documents needed at University Health Care to better care for your patient.
- Satisfaction Survey Form
Print and fax this to the Transfer Center to help us improve our services.
- Medication Record
Provided by pharmacy services for your use.