Hashimoto's Disease (Chronic Autoimmune Thyroiditis; Chronic Lymphocytic Thyroiditis; Hashimoto’s Thyroiditis)

Diagnosis
Hashimoto's disease (chronic autoimmune thyroiditis; chronic lymphocytic thyroiditis; Hashimoto’s thyroiditis)
Department
Cardiology; Endocrinology and Diabetes; Pediatric Endocrinology; Otolaryngology and Head and Neck Surgery

1. Start the referral process:

Use your own referral form or notes* or download one of our forms:

2. Gather records:

For adult referrals, Cardiology:

  • No records required

For adult referrals, Endocrinology and Diabetes:

  • Recent chart notes related to diagnosis
  • Labs supporting diagnosis
  • TSH

For Pediatric Endocrinology:

  • Chart notes
  • Growth charts
  • Labs

For adult and pediatric referrals, Otolaryngology and Head and Neck Surgery:

  • Relevant Imaging (Ultrasound, CT Scans, PET Scans)
  • Recent Relevant Labs (TSH, Free T4, Metabolic Set, etc.)
  • Records and testings requirements determined by provider who completed medical review.

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