To request a Non-Acute Inpatient Transfer please call 877-MD-REFER (877-637-3337).
After you submit this form, our office will work directly with the patient to schedule an appointment and assist with registration if needed. Referring providers will be notified of appointment details. You may also speak with a representative directly Monday – Friday, 8:30 am to 5:00 pm EST by calling 857-238-3838.
Important note: Some questions on this form may appear or disappear based on your responses.
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