New Patient Supporting Documents for the Pulmonary Clinic

Diagnosis /Symptom: Asthma, Recurrent Cough or Wheeze

What should the referring provider send?

1. A complete list of all medications
2. Medical records regarding relevant past evaluation and treatment, including:
   
   • Previous medical records related to the reason for consultation including relevant
   • ED/hospitalizations, clinic notes, and medication history or attempted therapeutic interventions
   • Medical history since birth (summary) including growth chart
   • Copy of any pulmonary function testing
   • All lab results pertaining to the problem including allergy testing
   • CD of any chest radiographs/imaging
   • Other key pieces of information…

Diagnosis /Symptom: Bronchopulmonary Dysplasia, Chronic Lung Disease

What should the referring provider send?

1. A complete list of all medications
2. Medical records regarding relevant past evaluation and treatment, including:
   
   • History including birth history including NICU course and respiratory history since birth
   • SpO2 values
   • Echocardiograms
   • Growth chart
   • CD of chest radiographs
   • Current treatments
   • Current supplemental oxygen requirement
   • Copy of any pulmonary function testing
   • Other key pieces of information…

Diagnosis /Symptom: Cystic Fibrosis

What should the referring provider send?

1. A complete list of all medications
2. Medical records regarding relevant past evaluation and treatment, including:
   
   • Copy of genotype/sweat chloride test results
   • Growth chart (weight, length, BMI)
   • Copy of annual CF labs
   • Copy of respiratory culture results
   • Copy of pulmonary function testing and trends
   • Copy of recent home healthcare plan from clinic
   • CD of most recent chest radiographs/CTs or relevant imaging
   • Other key pieces of information…

Diagnosis /Symptom: Sleep Disorders

What should the referring provider send?

1. A complete list of all medications including OTC medications
2. Medical records regarding relevant past evaluation and treatment, including:
   
   • Pertinent history and physical
   • Growth chart
   • Recent lab results
   • Prior ENT evaluations, sleep evaluations or sleep studies
   • Sleep log for 2 weeks (time to bed, time of naps, time wakes up)
   • Interventions tried
   • For insomnia/restless sleep, ferritin level
3. Other key pieces of information…