CCGO | For Referring Providers

For Referring Providers

The Referring Process

Central California Gynecologic Oncology evaluates most new patients on an outpatient basis. Once you’ve contacted us, your referral request will be reviewed, and we will notify you and your patient within three business days to arrange an appointment. You and your patient may be asked to provide additional information to ensure a comprehensive consultation.

Before we confirm your patient’s appointment, we will collect insurance information, verify benefits and seek financial authorization. If the patient is uninsured or unable to pay for services, we can connect them with a social worker to expedite the process of obtaining insurance.

Select patients may qualify for our office’s sliding fee payment program to defray the cost of the office visit.

After the evaluation is complete, you’ll receive a written report of the findings and recommendations.

Referrals can be made by


Secure Email
Email this referral form to
referrals@ccgomd.com.


Fax
Fax this referral form to
559-451-3680.

Required Referral Information

Patient Information
1. Name
2. Date of Birth
3. Phone numbers (home, mobile, and/or emergency contact)
4. Insurance plan
5. Diagnosis/Consult Question

Referring Provider Information
1. Provider Name
2. Office Contact
3. Office Phone
4. Office Fax

Attachments
1. Patient Insurance card / demographics
2. H&P and most recent progress note
3. Operative reports
4. Pathology reports
5. Tumor marker trends (i.e. CA125, CA 19-9, CEA, AFP, βHCG)
6. Imaging (i.e. CT, PET, MRI, ultrasound) in past year
7. Chemotherapy treatment records
8. Radiation treatment summary

For urgent referrals or questions about the referral process, please call our office for assistance at 559-451-3676, Monday – Friday, 9am-5pm.