REQUIRED INFORMATION FOR REFERRALS:

Cardiology referrals (All):

Please include reports for prior non-invasive stress test and / or coronary angiography. 

Please also include results of, or consider obtaining, as appropriate: 

1. Cardiac risk factor labs (Hgb A1C, Lipid panel)
2. Baseline ECG
3. Echocardiogram
4. Chest imaging (Chest x-ray or chest CT) 

Syncope / presyncope / palpitations: Please include reports, or consider obtaining cardiac monitoring.

• 24-48 hour holter for daily symptoms.
• 2-14 day holter for every other day to weekly symptoms. 
• Consider 14 day holter for symptoms that occur every 1-2 weeks.
• Holter monitoring is low yielf for symptoms occurring less frequently than every 2 weeks.

Pulmonology referrals (All):

Please include reports for, or consider obtaining:

1. Pulmonary function test reports
2. Recent chest imaging (CXR or chest CT). 

For the issues below, please include results of, or consider obtaining:

Dyspnea NYD / Pulmonary hypertension:  

1. PFTs, 
2. BNP, 
3. Echocardiogram, 
4. Sleep study.

GI referrals (All):

Please include reports for prior endoscopy:

For the issues below, please include results of, or consider obtaining: 

Iron deficiency anemia:

1. CBC with reticulocyte count
2. Iron indices (Ferritin, transferrin, transferrin saturation).
3. H Pylori antigen + Celiac panel (Anti-TTG + total IgA)

Chronic diarrhea:

1. Stool C&S, O&P
2. H Pylori antigen
3. Celiac panel (Anti-TTG + total IgA).

Chronic abdominal pain

1. H Pylori antigen
2. Celiac panel (Anti-TTG + total IgA)
3. Abdominal imaging (Abdo / pelvis CT preferrable, otherwise ultrasound) 

Transaminitis / liver synthetic dysfunction NYD:

1. Liver enzymes (ALT, AST, ALP +/-, GGT)
2. Liver synthetic indices (Total bilirubin, INR, Albumin, platelet count)
3. Hepatitis B/C serology
4. Iron indices (Ferritin / Transferrin / Transferrin saturation)
5. Ceruloplasmin
6. Alpha 1 anti-trypsin
7. Autoimmune panel - ANA, Anti-smooth muscle antibody, anti-mitchondrial antibody
8. abdominal u/s (including portal vein doppler to rule out thrombus and assessment for radiologic signs of cirrhosis and biliary tract dilation)
9. Liver elastography - Fibroscan

Unintended weight loss NYD 

1. Iron indices (Hemoglobin, Ferritin, transferrin, transferrin saturation, reticulocyte count),
2. Nutrition indices - Albumin / INR / Vitamin B12 level
3. TSH
4. CT Chest/abdo/pelvis  

For the issues below, please include results of, or consider obtaining: 

Hyperthyroidism:

1. TSH
2. Free T4/T3
3. Radioactive uptake iodine scan (RAI-U) scan (If no RAI-U scan, please consider Thyroid receptor antibodies (TRAB)).

Calcium disorders

1. Calcium + albumin OR ionized calcium 
2. Phosphate (PO4)
3. Parathyroid hormone (PTH)

Stroke prevention:

1. CVA risk factor labs (Hgb A1C, Lipid panel),
2. neurovascular imaging with non-contrast computed tomography (NCCT) and including CT angiography (CTA),
3. echocardiogram.

* Consider obtaining 14 day holter monitor to assess for atrial fibrillation for patients with embolic ischemic stroke or transient ischemic attack of undetermined source whose initial short-term ECG monitoring does not reveal atrial fibrillation, but a cardioembolic mechanism is suspected, and patient the patient is not already receiving anticoagulant therapy and would be a candidate.