New Patient Supporting Documents for Pediatric Adolescent Medicine


The following information pertains to patients ages 12 to 21.

Diagnosis /Symptom: Adolescent Behavioral Medicine

What should the referring provider send?

  1. Pertinent medical records

Diagnosis /Symptom: Chronic Fatigue

What should the referring provider send?

  1. Pertinent medical records
  2. Growth charts
  3. Radiographic reports
  4. Relevant laboratory studies
  5. List of all medications 

Diagnosis /Symptom: Chronic Somatic Complaints

What should the referring provider send?

  1. Pertinent medical records
  2. Growth Charts
  3. Radiologic reports
  4. Relevant laboratory studies
  5. List of all medications

Diagnosis /Symptom: Eating Disorders

What should the referring provider send?

  1. Pertinent medical records
  2. Growth Charts
  3. Relevant laboratory studies
  4. List of all medications

Diagnosis /Symptom: Adolescent Gynecology

What should the referring provider send?

  1. Pertinent medical records
  2. Growth Charts
  3. Radiographic reports
  4. Relevant laboratory studies
  5. List of all medications

Diagnosis /Symptom: Family Planning

What should the referring provider send?

  1. Pertinent medical records

Diagnosis /Symptom: Gay, Lesbian, Bisexual and Transgender, Questioning Youth/Young Adult Care (GLBTQ)

What should the referring provider send?

  1. Pertinent medical records

*Note: Younger ages accepted on a case-by-case basis.

Diagnosis /Symptom: HIV Care, Testing, and Prevention Services

What should the referring provider send?

  1. Pertinent history and physical
  2. Pertinent lab work