New Patient Referral

Please fax the following information to (260) 446-3659 

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
A copy of their insurance card

You may also send them as a direct message to admin@fwmoh40.OncoEMRDirect.com