Gastrostomy Tube Placement (GI Tube in Place)

Diagnosis
Gastrostomy tube placement (GI tube in place)
Department
Pediatric Gastroenterology; Pediatric Surgery

1. Start the referral process:

Use your own referral form or notes* or download our form:

Pediatric referral form

2. Gather records:

For Pediatric Gastroenterology:

  • Growth chart
  • Labs
  • Imaging

For Pediatric Surgery:

  • Test: Upper GI
  • Any records from PCP, or referring provider
  • Any imaging or tests done for this dx
  • Any past surgical records for this dx

3. Fax the referral and all records to 503-346-6854.

* Referral notes or forms should include:

  • Patient name, date of birth, sex, address and phone number
  • Referring provider’s name, address and phone number
  • Diagnosis or reason for referral
  • Department patient is being referred to
  • Most recent chart notes supporting the diagnosis or reason for referral

For help or to arrange provider-to-provider advice, call 503-494-4567.

Date Revised May 01, 2024