Refer a Patient: Pediatric Inherited Cardiac Arrhythmias Program

How to Refer a Patient

1. Have your patient call 877-UC-CHILD:

Your patient can call 877-UC-CHILD (877-822-4453) now for an appointment. We can schedule the visit while you're preparing the referral – there's no need to wait.

2. Gather required documents

• A copy of your patient's insurance card and authorization
• Clinical documentation, including reports and images from previous cardiac testing and procedures

3. Fill out the referral form

Download the Pediatric Cardiology Referral Request Form. It's a fillable PDF, so you can complete it on your computer screen.

For "Services Requested and CPT codes," please mark "Other" and note that you're referring to the inherited arrhythmias program.

Download referral form

4. Fax everything to (415) 353-4485

Send the completed referral form and required documentation, using this fax number for all clinic locations: (415) 353-4485.

Where to Call for Help

If you have questions, please call the Pediatric Heart Center:

M-F, 8 a.m. - 4:30 p.m.
(415) 353-2008 (San Francisco)
(510) 428-3380 (Oakland)