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New Patient Referral

A physician’s referral is not necessary, but always welcome.

Referring physicians are asked to fax the following information to (260) 446-3659 or send as a direct message to:  admin@fwmoh40.OncoEMRDirect.com

  • Referring physician office notes
  • Medication list
  • Surgery Report
  • Labs
  • Pathology reports (including ER/PR/Her2/neu/FISH or any special stains)
  • Oncotype Dx (if performed)
    BRCA 1, BRCA 2 testing (if done)
  • Mammogram
  • Breast MRI and/or Ultrasound
  • Any additional radiology reports pertaining to breast cancer diagnosis
  • Pulmonary Function Test
  • Any PET CT CXR Scans and radiology reports pertaining to hematologic diagnosis
  • If DVT diagnosis, please include all ultrasounds the patient has relating to the DVT diagnosis
  • Copy of the patient’s insurance card