Refer a Patient

Refer a Patient to Indiana University Health North Hospital

Referral Forms

• Esophageal & Gastric Surgery Center Referral Form
• Imaging Services Referral Form
• Minimally Invasive Surgery Center Referral Form
• Sleep Disorders Center Referral Form
• Spine Clinic Referral Form
• Women's Diagnostic Referral Form

Pre-Op Referral Forms

• Orthopedic Pre-Op Orders
• General Surgery Pre-Op
• Gynecology/Urogynecology Pre-Op
• Urology Pre-Op
• Outpatient Surgery - History & Physical/Pre-Op Orders
• Pre-Op Lab Guidelines

Other Forms

• Surgery Scheduling Form - IU Health North Hospital
• Record of Short Stay
• Pre-Admission Testing Referral & Screening
• Consent for Procedure
• Physician's Orders

 

For all other patient referrals to IU Health North Hospital, use the General Patient Referral Form.