Thank You for Your Referral

We appreciate your support.

We have received your Online Patient Referral and will be in contact with you and the patient as soon as possible. Please Print This Checklist for Your Records

In preparation for the appointment we ask that you please use this checklist to make sure all the appropriate information is sent to us.

Please FAX the Following to us:
-History and Physical Examination Notes from all Physicians (PCP, Surgeon, Specialist, Medical Oncologists)
-Followup Notes from all Physicians (PCP, Surgeon, Specialist, Medical Oncologists)
-PETCT Scan Reports
-CT Scan Reports
-MRI Scan Reports
-X-Ray Reports
-Bone Scan Reports
-Surgery AND Biopsy Operative Reports
-Pathology Reports
-Lab Tests (PSA, etc)

Please MAIL the following to us:
-PETCT Scan CD (Preferred Over Films)
-CT Scan CD (Preferred Over Films)
-MRI Scan CD (Preferred Over Films)
-X-Ray CD (Preferred Over Films)
-Bone Scan CD (Preferred Over Films)
-Pathology Slides (To be reviewed at Alta Bates Medical Center)

Please Note:
If you have received ANY radiation in the past at any institution other than Alta Bates Summit Medical Center, please provide the following list to your local Radiation Oncologist’s Medical Records Office and have them send to us the following items for review.

Please FAX the Following to us:
-Radiation Oncology Consultation
-Radiation Oncology Prescription / Daily Treatment Record
-Radiation Oncology Plan
-Radiation Oncology Fields (Picture of Each Field / Blocks)
-Radiation Oncology Dose Volume Histograms (DVH’s)
-Radiation Oncology Treatment Summary

Please MAIL the following to us:
-Radiation Oncology Port Films (The actual Radiation Oncology Treatment x-ray films (Port Films) and Color Printouts of each Field and Dose Distribution.)

Our MAILING Address Is:
Alta Bates Summit Medical Center
ATTN: New Patient Coordinator
Department of Radiation Oncology
450 30th Street
Room G800, Peralta Pavilion
Oakland, California 94609-3302
TEL: (510) 869-8889
FAX: (510) 869-6680

Our FAX Number Is:
FAX: (510) 869-6680

Thank you for entrusting your care to us.

We look forward to serving you.

Sincerely,
Dr. John Salzman
Dr. Gopal Sachdeva
Dr. Valery Uhl

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