New Patient Supporting Documents for Urology Department


Looking for Referral Guidelines? 

Diagnosis: Urinary Tract Infection

What should the referring provider send?

  1. A complete list of all medications used to treat the UTI (both acutely or for prophylaxis) along with a list of other medications taken, specifically if constipation has been treated
  2. Medical records regarding relevant past evaluation and treatment of UTI
  3. Any Urinary tract, abdominal or spinal imaging or films,
  4. Relevant laboratory reports, in particular urine cultures or UA’a
  5. Parent’s written voiding calendar indicating over a 2 day period (if the family could bring this with them):
    • Date and time of day of each void,
    • Episodes of incontinence
    • Time of bowel motion
    • If possible a measurement of fluid intake

Diagnosis: Voiding dysfunction/urinary incontinence

What should the referring provider send?

  1. A complete list of all medications used to treat the voiding dysfunction along with a list of other medications taken, specifically if constipation has been treated
  2. If there is a history of UTI
    • Medical records regarding relevant past evaluation and treatment of UTI
  3. Any Urinary tract, abdominal or spinal imaging or films
  4. Relevant laboratory reports, in particular urine cultures or UA’a
  5. Parent’s written voiding calendar indicating over a 2 day period (if the family could bring this with them):
    • Date and time of day of each void,
    • Episodes of incontinence
    • Time of bowel motion
    • If possible a measurement of fluid intake

Diagnosis /Symptom: Hydronephrosis

What should the referring provider send?

  1. A complete list of all medications (both acutely or for prophylaxis).
  2. Medical records regarding relevant past evaluation and treatment of the hydronephrosis, where relevant prenatal history
  3. Any imaging  or films both pre and post natal
  4. Relevant laboratory reports, in particular urine culture or renal blood profile if taken