Referral Information Forms
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Referral/Consultation Request Form
To ensure continuity of care for the patient and to clarify if the request is for an opinion or transfer of care, please use the Referral /Consultation Request Form 
and fax to the appropriate department when scheduling an appointment.
Cardiac CTA Referral Form
To refer a patient for a cardiac CTA, use the CCTA Physician Referral Forms below.
Referral Form for PET/CT
To refer a patient for a PET/CT scan, use the Referring Physician PET/CT - Ordering Form .
Referral Form for Pain Management
To refer a patient for Pain Management use this form . Include a letter of referral with the patient.
MeritCare Children's Referral Directory
If you need to transfer a young patient to MeritCare Children's Hospital, or if a child requires pediatric specialty care, use the Children's referral telephone directory.
PICU Consultation and Transport Criteria
If your patient meets the PICU consultation and transport criteria , refer directly to MeritCare Children's PICU by calling (800) 437-4010 and asking for the pediatric intensivist on call.
NICU Consultation and Transport
Neonatal emergency medical information . If you need to consult with or refer to MeritCare Children's NICU call (800) 443-4779 (Press #1).