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Referral Guidelines and Request Forms

Referral guidelines and forms are available to assist physicians in the evaluation and management of pediatric patients.

Developed by CHOC physicians, in partnership with community physicians, these guidelines provide you with useful information in working up your patients, and contribute to making the appointment itself most meaningful by having the right clinical information available.

Listed below are the specialties that currently have guidelines and forms. Updates, as well as additional specialties and diagnoses, are added regularly.

Allergy & Immunology

Cardiology

Endocrinology

  • CHOC Children’s Specialists Endocrinology Referral Guidelines
    Growth Disorders, Thyroid Disorders and Pubertal Disorders including, Congenital Hypothyroidism (Neonate), Congenital Hypotheyroidism (Child), Acquired Hypothyroidism, Autoimmune Thyroiditis/Hypothyroidism, Central Hypothyrodism, Acquired Hyperthyroidism, Auntoimmune Hyperthyroidism (Grave’s Disease), Neonatal Hyperthyroidism, Goiter, Thyroid Nodule, Diabetes Mellitus Type 1 & Type 2, Hyperglycemia, Impaired Glucose Tolerance, Impaired Fasting Glucose, Morbid Obesity, Acanthosis Nigricans, Short Stature, Failure to Thrive, Precocious Puberty/Premature Thelarche (Girls), Precocious Puberty (Boys), Premature Adrenarch (Girls), Premature Adrenarch (Boys), and Delayed Puberty.
  • CHOC Children’s Specialists Endocrinology Referral Request Form
    General Endocrinology Clinic, Growth Clinic, Diabetes Clinic
  • CHOC Children’s Specialists Endocrinology Practice Profile
    Provides a one-sheet resource of commonly treated conditions, services offered, location and contact information for referrals. For more comprehensive information, please see the Referral Guidelines.

Gastroenterology

Hematology

Hospitalist

Infectious Disease

 Metabolic Disorders

  • CHOC Children’s Specialists Metabolic Disorders Referral Guidelines
    Developmental Regression / Cognitive Impairment, Hypotonia, Stroke-like Episodes, Intermittent Ataxia, Altered Mental Status, Medically Refractory Seizures, Failure to Thrive / Cyclic Vomiting, Recurrent Hypoglycemia, Abnormal Laboratory / Imaging Findings, Family History of Inborn Errors of Metabolism / SIDS, Positive Newborn Screening for Metabolic Disorders, Urea Cycle Disorders, Organic Acidurias, Amino Acid Disorders, Vitamin and Cofactor Disorders, Carbohydrate Metabolism Disorders, Fatty Acid Oxidation Disorders, Mitochondrial Disorders, Neurotransmitter Disorders, Lysosomal Storage Diseases. Peroxisomal Disorders, Creatine disorders, Purines & Pyrimidines disorders, Congenital Disorders of Glycosylation (CDG)
  • CHOC Children’s Specialists Metabolic Disorders Practice Profile
    Provides a one-sheet resource of commonly treated conditions, services offered, location and contact information for referrals.

Neonatology

Nephrology

Neurology

Neurosurgery

Orthopaedics

Otolaryngology

Pediatric General and Thoracic Surgery

  • CHOC Children’s Specialists Pediatric General and Thoracic Surgery Practice Profile
    Provides a one-sheet resource of commonly treated conditions, services offered, location and contact information for referrals.
  • Pediatric General and Thoracic Surgery Referral Guidelines
    Anal Fistula, Abdominal Pain, Balanitis, Branchial Cleft, Circumcision, Crohn’s Disease, Dialysis, Epigastric Hernia, Failure to Thrive, Gallstones, Ganglion, Gastroschisis, Gastrostomy Tube, GERD, Hematochezia, Hernia (Inguinal), Hernia (Umbilical), Hydrocele, Lung Mass, Mass (Abdominal), Mass (Breast), Mass (Cheek), Mass (Ext Upper), Mass (Head/Scalp), Mass (Mediastinum), Mass (Neck), Mass (Pelvic), Mass (Testes), Mass (Thyroid), Mass (Trunk), Omphalocele, Pectus Carinatum, Pectus Excavatum, Pilonidal Disease, Polydactyl (Finger), Polydactyl (Toe), Preauricular Cyst, Prenatal Consult, Pyloric Stenosis, TEF, Thyroglossal Duct Cyst, Ulcerative Colitis, Undescended Testes, Vascular Access, Vomiting

Plastic Surgery

Pulmonology

Radiology

Rheumatology

Urology

  • CHOC Children’s Urology Center Referral Guidelines
    Balanitis, Bladder Stones, Circumcision (elective), Cloacal Anomaly, Congenital Adrenal Hyperplasia, Congenital Cystic Kidney, Duplicated Collection System, Dysfunctional Voider, Dysuria, Dysuria (psychogenic), Fistula (urethrocutaneous), Frequency, Hematuria (gross), Hematuria (microscopic), Hernia (inguinal), Hidden Penis, Hydrocele, Hydronephrosis, Hydronephrosis (congenital), Hypospadias (male), Incontinence (urine – non specific), Kidney Stones, Labial Adhesions, Meatal Stenosis, Megaureter, Megaureter (congenital), Micro Penis, Multi Cystic Dysplastic Kidney, Neonatal Circumcision, Neurogenic Bladder, Nocturnal Enuresis, Paraphimosis, Penile Adhesions, Penile Curvature, Phimosis, Posterior Urethral Valves, Pyelonephritis, Solitary Kidney, Spina Bifida (occulta), Testicular Pain, Testicular Pain (psychogenic), Torsion, Undescended Testis, Urachal Remnant, Ureteral Stones, Ureterocele, Ureteropelvic Junction (UPJ) Obstruction, Urethral Stones, Urethral Stricture, Urinary Retention, Urinary Tract Infection, Varicocele, Vesicoureteral Reflux, Vesicoureteral Reflux (bilateral), Vesicoureteral Reflux (nephropathy), Vesicoureteral Reflux (unilateral)
  • CHOC Children’s Urology Center Referral Request Form
    Download a PDF of the CHOC Children’s Urology Center Referral Request Form
  • CHOC Children’s Urology Center Practice Profile
    Provides a one-sheet resource of commonly treated conditions, services offered, location and contact information for referrals. For more comprehensive information, please see the Referral Guidelines.

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UC Irvine

CHOC Children's is affiliated with the UC Irvine School of Medicine