Asthma Clinic

Appropriate patients for referral:

• Patients with refractory asthma having difficulty controlling symptoms despite appropriate treatment
• Patients needing evaluation of their current asthma management plan
• Patients with recent ED visit or hospitalization for asthma
• Patients with chronic urticaria
• Patients with immunodeficiency
• Patients with chronic sinusitis
• Patients needing skin testing for allergen avoidance counseling

Documentation required for scheduling an appointment:

1. Completed Referral form
2. Past Medical History (PMH)
3. Current medication list
4. Most recent progress note describing condition for which patient is being referred.
5. If reports are available, include with referral. If patient has not had testing, reports are not required for scheduling appointment.
   Examples of report: chest films, pulmonary function testing, labs, skin testing results.

Revised May 2015

Have questions or comments about the specialty referral guidelines? Submit them here.