Specialty Referrals

Introduction

For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing "Refer to" and then select "ENTER"

• Refer to ___ Internal means you are referring a patient within the YKHC system
• Refer to ______ External means you are referring a patient outside the YKHC system

­INTERNAL referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.

• Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
• Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
• Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with anmc (lower case).

EXTERNAL referrals are indicated when the patient needs to travel to see the specialist.

• External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

For all referrals, the provider documentation should:

• Specify the reason for the referral with as much past medical information as possible
• Include Beneficiary/Non-Beneficiary status
  • If a non-beneficiary, case management will also need the name of the provider they want to see
  • If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
• Indicate what, if any, Multimedia files are applicable to case
  • Images and/or scanned documents should be uploaded into Multimedia
  • Dermatology always wants pictures
  • Case management will need to know which Multimedia files should accompany an external referral
• Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
• Include current patient contact information. If a peds referral, also include escort name/DOB.

Please, do not enter multiple referrals for the same patient, same problem. This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

Case Management does not make ANMC appointments. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

Referrals from the ER

1. Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
2. Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
3. Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.

return to the Emergency Department Main Page

ACT/Behavioral Health

• Be sure to include good contact numbers
• Include a statement indicating that the patient agrees to talk to Behavioral Health.

Allergy/Immunology

Orders Available

• Refer to Allergy/Immunology External

Clinics Available

• ANMC Allergy/Immunology Clinic
• Allergy, Asthma, and Immunology Center of Alaska

Cardiology (Adult)

Orders Available

• Refer to Adult Cardiology External

Things to include

• labs
• Chest X-ray (if indicated)
• ECG (REQUIRED)

Clinics Available

• ANMC Cardiology
  • all referrals are reviewed for possible scheduling at Bethel Field Clinic

any time you consult with a Cardiologist at ANMC who requests that a patient be seen in the cardiology field clinic at YKHC, please send the patient information over to Case Management to coordinate scheduling

Cardiology (Pediatrics)

Orders Available

• Refer to Peds Cardiology External/Internal

Available Groups

• Alaska Children's Heart Center (External Only)
• Seattle Children's Pediatric Cardiology
  • Have a Bethel Field Clinic

Colonoscopies/EGDs

Do NOT order a referral to GI for EGD/CS

Orders Available

• For Colonoscopy/EGD procedures to be done in Bethel,
  • Refer to Adult Surgery Internal (YK Colonoscopy)
    • Refer to Adult Surgery Internal - YK EGD
  • For Colonospcopy/EGD procedures to be done at ANMC
    • Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
    • There is no ANMC Surgery Internal Referral.
• In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).

Colonoscopy

• If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
• If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
• If you are not sure, contact the on-call anesthetist or Dr. Compton.
• The queue is managed by the Surgery Case Manager.

To screen for colon cancer when the patient cannot do a colonoscopy

• The provider orders the test.
• The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
• The patient collects the sample per instructions.
• The patient brings it back to the village lab or the YK lab.
• The specimen is transported to the YK lab by policy.
• The YK lab runs and results the test.

EGD

• If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
• If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
• If you are not sure, contact the on-call anesthetist or Dr. Compton.
• The queue is managed by the Surgery Case Manager.

Dental

• All referrals are processed through YKHC Dental Department.
• Referrals to ANMC must be processed through YKHC Dental.
• If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

Dermatology

Orders Available

• Refer to Dermatology External

Things to Include

• treatments/medications previously tried
• Derm requires pictures

Dermatology (Pediatric)

Orders Available

• Refer to Pediatric Dermatology External

Clinics Available

• ANMC Dermatology Clinic
• Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

Developmental (Pediatric)

Orders Available

• Refer to Family, Infant, Toddler Program Internal
• Refer to Child Family Developmental Services External
• Refer to Peds Other External (Ability Clinic)

see Specific Pediatric Processes Section about Developmental Delay for more details.

Endocrinology (Adult)

Orders Available

• Refer to Adult Endocrinology External

Things to Include

• Consider TSH, T3, Free T4

Endocrinology (Pediatric)

Orders Available

• Refer to Peds Endocrinology External/Internal

Clinics Available

• ANMC Peds Endocrinology Clinic
  • Bethel Field Clinic 3-4 times a year

Gastroenterology (Adult)

Orders Available

• Refer to Adult Gastroenterology External

Clinics Available

• ANMC Gastroenterology Clinic
• Internal Medicine Associates

Gastroenterology (Pediatric)

Orders Available

• Refer to Peds Gastroenterology External

Clinics Available

• Providence Pediatric Gastroenterology Clinic
• Seattle Children's Hospital Gastroenterology Clinic

Hematology/Oncology (Pediatric)

Orders Available

• Refer to Peds Hematology/Oncology External

Available Clinics

• AK Pediatric Hem-Onc Clinic
• ANMC Peds Hem-Onc Clinic

Hepatology (Adult)

Orders Available

• Refer to Adult Hepatology External
• refer to Adult Hepatology Internal

Things to Include

• Liver Ultrasound
• Liver Panel
• Hepatitis B panel if patient has Hepatitis B

Imaging (Pediatric EEG/VFSS/Hip US)

Orders Available

• Refer to Pediatric Clinic External (EEG/VFSS/Hip US)

Studies completed at facilities outside YKHC

MRI (Adult)

Orders Available

• Refer to Internal Medicine External

Things to Include

• answer all yes/no questions on order (REQUIRED)

MRI (Pediatric)

Order Available

• Refer to Pediatric Clinic External: MRI

Required information

• Reason for referral
• Sedation required: yes or no
• Contrast?: yes or no

Nephrology (Adult)

Orders Available

• Refer to Adult Nephrology External

Things to Include

• Renal ultrasound
• labs including Renal panel, UA, UPCR, CBC

Nephrology (Pediatric)

Orders Available

• Refer to Peds Nephrology External

Clinics Available

• Providence Pediatric Nephrology
• Seattle Children's Pediatric Nephrology

Neurology (Adult)

Orders Available

• Refer to Adult Neurology External
• Refer to Adult Neurology External-Back/Neck Eval
• Refer to Adult Neurology Internal

Things to Include

• CT or other imaging within the last 6 months

Neurology (Pediatrics)

Orders Available

• Refer to Peds Neurology External
• Refer to Peds Neurology Internal

Available Clinics

• Providence Pediatric Neuroscience
• ANMC Pediatric Neurology Clinic
  • for urgent/emergent referrals
• Seattle Children's Pediatric Neurology
  • for non-urgent and chronic management
  • providers very available for questions (see Pediatric Reference Guide for contact information)
  • Bethel Field Clinic 3-4 times a year

Neurosurgery

Orders Available

• Refer to Neurosurgery External

Things to Include

• X-ray within last 6 months (REQUIRED)

OB/GYN Referrals

Orders Available

• Refer to Gynecology External
• Refer to Gynecology Internal

Refer GYN INTERNAL

• order: "Refer to Gynecology Internal"
• The queue is managed by GYN Case Managers.
• Almost all referrals should start here as most insurance will require that the patient be seen locally first.
• for patients you want Dr. Compton to see for a consultation in the clinic
• These should be services specific to GYN consultation only- if you have questions message or call the gyn case manager – appts are limited.
• Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

Refer GYN - External

• for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond
• order: "Refer to Gynecology External"
• The queue is managed by GYN Case Managers.
• Important things to remember or talk with patients about:
  • If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. The gyn case manager can still send the referral, but it’s always nice that patients know this ahead of time.
  • We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

Optometry/Ophthalmology

• All referrals are processed through YKHC Optometry.
• Referrals to ANMC must be processed through YKHC Optometry.

Ophthalmology (Pediatric)

Orders Available

• Refer to Chronic Peds Ophthalmology External

Clinics Available

• ANMC Ophthalmology
  • all referrals sent here
• Alaska Children's Eye and Strabismus
  • some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here

Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.

Orthopedics

Orders Available

• Refer to Orthopedics External
• Refer to Orthopedics Internal
• Refer to Hand Orthopedics External

Things to Include

• current X-rays

Resources Hand Orthopedics 2019 (PowerPoint Presentation)

Pain Management

Orders Available

• Refer to Pain Management External

Things to Include

• Comprehensive Pain Management Questionnaire (REQUIRED)
  • have patient fill out at appointment and turn in before leaving
• X-rays within the last 6 months

Pulmonology (Adult)

Orders Available

• Refer to Adult Pulmonology External

Things to Include

• Chest X-ray
• labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

Rheumatology (Adult)

Orders Available

• Refer to Adult Rheumatology External
• Refer to Adult Rheumatology Internal

Things to Include

• X-rays if deformities present
• labs including CBC, CMP, CRP, ESR, and others as needed

Rheumatology Referral Process Guidelines

Surgery (General)

You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

Anyone needing to be seen by surgery will need an accepting physician so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

Orders Available

• Refer to Adult Surg Ext (no EGD/CS)
• Refer to Adult Surg Ext (only EGD/CS)
• Refer to Adult Surgery Internal - YK EGD
• Refer to Adult Surgery Internal - YK General
• Refer to Adult Surgery Internal (YK Colonoscopy)

ANMC Adult Surgery Referrals

• order: "Refer to Adult Surg Ext (no EGD/CS)"
• Stages

1. CM in Bethel collects information and sends it to Anchorage.
2. CM in Anchorage reviews the information and presents it to a provider.
3. The provider makes a decision.

If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.

Vasectomy or other minor procedures to be done in Bethel

• Order: "Refer to Adult Surgery Internal - YK General"
• The queue is managed by the Surgery Case Manager.

For Everything Else

• Order: "Refer to Adult Surgery External (no EGD/CS)"
• The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

Urology (Adult)

Orders Available

• Refer to Adult Urology External
• Refer to Adult Urology Internal

Things to Include

• labs including UA, Urine Protein/Creatinine
• Renal US (if indicated)
• If referring for sterilization, consent to sterilize (REQUIRED)
  • Complete and sign with the patient at visit

Non-Beneficiaries

• Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
• Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
• Providers/Nurses can always google Providence Hospital
  • click on website
  • click on Find a Doctor
  • search for specialties
  • put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)
  • there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.
  • A couple choices would be nice.
  • Also let patient know that they will need to make sure that the office accepts their insurance.

PEDIATRIC Specialty Services

General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the PEDS REFERENCE PHONE NUMBERS in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See Consultations YKHC Clinical Guideline -be quick and concise with both your YK as well as external consults.

Pediatric specialist referrals:

• Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
• The referral orders for ENT are a good resource: for the indications for BMT and T&A.

Orders Available

• Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see Developmental Delay Section for more details)
• Refer to Family, Infant, Toddler Program Internal (see Developmental Delay Section for more details)
• Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
• Refer to Peds Cardiology External/Internal
• Refer to Peds Endocrinology External/Internal
• Refer to Peds Gastroenterology External
• Refer to Peds Hematology/Oncology External
• Refer to Peds Nephrology External
• Refer to Peds Neurology External
• Refer to Peds Neurology Internal
• Refer to Peds Other External
• Refer to Peds Psychiatry Internal
• Refer to Peds Pulmonology External
• Refer to Peds Pulmonology Internal
• Refer to Peds Rheumatology External
• Refer to Peds Surgery External
• Refer to Peds Urology External
• Refer to Chronic Peds Ophthalmology External
• Refer to Devt/Behavioral Peds External

Pediatric Specialty Bethel Field Clinics

We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:

• Pulmonary (from Seattle Children's Hospital) three to four times a year
• Endocrinology (from ANMC) three times a year
• Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
• Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

Anchorage Pediatric Specialty Services

These and more specialty services are also available in Anchorage. Please look at the Pediatric Specialty Services Grid for more details.

Developmental Delay Services

To refer a patient with developmental delay for services, please see the Pediatric Developmental Delay Section for more details.

• Family Infant Toddler (FIT)
  • For children less than 3 years old
• Infant Learning Program (ILP)
  • Anchorage based equivalent of FIT (see their website here)
  • children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
• Local School Department
  • for children older than 3 years old
  • discuss with parents to request ILP through their school system
  • many villages have Head Start Programs
• Ability Clinic in Anchorage
  • for children older than 3 years old and needing more intensive OT/PT/speech therapy
  • Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
• Multidisciplinary Neurodevelopmental Clinic
  • Order: "Refer to Child Family Developmental Services External"