To assist you with this, download the medication schedule (PDF). The Barnes-Jewish & Washington University Neuroscience Center offers expertise in movement disorders. for an EEG forms. We are unable to accommodate self-referrals or referrals directly from emergency departments. Schwab's vision by founding the Movement Disorders Center in 1982. The links section of our web site is a comprehensive list of valuable Ataxia related resources provided by other organizations. When you have a neurological disorder, it affects your body's nervous system. The Stanford Movement Disorders Center provides the full range of care for people with all types of movement disorders. The Center includes clinicians and researchers from the fields of neurology, neurosurgery, neuroscience, neuropsychology, speech and communication disorders, physical therapy/rehabilitation, psychiatry, neuropathology Movement Disorders Clinic: Treatments. org. 483. The Movement Disorders Clinics at the Perron Institute provide comprehensive management and treatment for people with a movement disorder, including very complex cases. Please include the following with this referral: Demographics cover sheet Copy of the patient’s ID & insurance card(s) Insurance authorization or referral as appropriate Clinic data to support the issues you want to address (H&P, clinic progress notes, prior diagnostic reports) Brain imaging on disc or transmitted electronically To begin the referral process, please complete our referral intake form online and fax it to our Physician Referral Center at 916-703-6048. Cognitive & Movement Disorder. It is a degenerative disorder that progresses slowly and is caused by the loss of dopamine-producing brain cells. These diseases often result in damage or abnormal function to an area of the brain that controls movement, called the basal ganglia. 3. All of the information you need to confidently refer your patient to one of our specialty clinics. Dr. The Movement Disorders Clinic has developed The Spasticity Treatment Center which coordinates the efforts of many physicians from different areas of medicine and surgery. Referral Process 8 Jul 2013 Identifying 'probable movement disorder' referrals as early as the carousel appointment and multi-disciplinary clinic form will save 150 hours  The Stanford Movement Disorders Center provides the full range of care for people with Ask your doctor's office to fax a letter of referral, contact information , insurance information Bring any MRI or CT films; Plan to be at the clinic for one to two hours Fax a referral form with supporting documentation to 650-320- 9443. For Parkinson's patients and their families, controlling symptoms and slowing disease progression is the top priority. The goals of this rotation are for the resident to: Movement Disorders Center. Asher is medical director of St. Referral to a movement disorder clinic occurred 4. O. They count on Cedars-Sinai ’s Parkinson's Disease Center—one of a limited number of programs supported by the American Parkinson Disease Association—for the latest treatments to help improve the quality of their lives. For patients, this specialized treatment can Adult and Pediatric Neurology Referrals for London Ontario and the Southwest LHIN. To register visit SFMatch, and click on Movement Disorder Fellowship, then click on Login/Register at the bottom of the left panel; follow the instructions to register as a candidate, and pay the $50 fee. Criteria (not all inclusive). The Division of Movement Disorders has been designated a Center of Excellence by the Parkinson Foundation (PF). As you are under the care of our Credentialed Sleep Physicians, a referral from your doctor is required. Southern California Movement Disorder Specialists provides some of the best attention deficit hyperactivity disorder treatment in the Los Angeles area. New patients are assigned to the first available neurologist, rather than the Physician Referrals Who can make a referral: We currently are accepting requests for new patient appointments from outpatient clinicians to whom we will send a report and recommend appropriate follow-up care with us or elsewhere. Treatments and Services. Experts at MU Health Care diagnose and treat many movement disorders. Periodic limb movement disorder causes the limbs, legs or arms to jerk and move during sleep. REFER A PATIENT Thank you for referring your patient to us. To contact a specific provider: Please use the phone number listed in Find a Provider. 7818). Find forms for new and returning patients. Referral ADHD/ADD Witnessed apnea Gasping episodes Adenoid Facies Blue Spells / Cyanosis Failure to thrive Trisomy 21 / other _____ Neuromuscular disorder Type: _____ Labored breathing during sleep Learning problems Sitting upright to sleep / neck High arched palate Daytime sleepiness (consider Sleep Clinic First) To request a consult from General Neurology or from a specific Neurology subspecialty clinic, please complete the online Referral Form. The Movement Disorders Clinic provides patient services and is operated by Vancouver Coastal Health. The clinic also conducts clinical research and assessment of genetic information. While there is no cure for movement disorders, treatment can help ease your symptoms and allow you to live a full, active life. Motor fluctuations were present in 68%. Our Services We provide subspecialty services in the following areas: … Continued For more information about the Movement Disorder Clinic, email us at tics@cchmc. Movement Disorder Clinic. Upon completion, please fax the form to (888) 491-5348. He serves on several medical boards, and is a charter member of the Movement Disorder Society. The faculty supervisors are Drs. Our team is service and research oriented. Sleep Disorders Clinic – Auburn SleepMed was created with the sole objective of being a modern facility for a form of disorders that have been so often brushed off by many patients, as well as physicians. Patients can only be seen by a movement disorder neurologist at our Centre upon acquisition of a referral from their primary physician or general neurologist. Movement disorder manifestations are characterized as either hyperkinetic (increased movement) or hypokinetic (decreased movement). Consistent use of best practices in daily care and discharge planning is the most significant leverage point for improving flow and reducing hospital occupancy while improving the patient experience. "This is a very odd movement disorder, and stranger still is the possible relationship to gabapentin. MULTIDISCIPLINARY CLINIC FOR PARKINSON’S DISEASE (PD) PATIENTS Patients may learn about the clinic and services provided by attending educational meetings sponsored by Parkinson Society British Columbia (PSBC), from allied health professionals in the community or from friends and family. Have your physician’s office fill out a referral form (Download the Neurology Department Referral Form here and download the Center brochure here) or fax your… Our division consists of nine movement disorder neurologists who specialize in the full range of neurological disorders that affect movement, such as Parkinson's disease and other Parkinsonian disorders, essential tremor and other tremor disorders, dystonia, tics and Tourette syndrome, myoclonus, ataxias, and other movement disorders. We see patients at two clinic locations: Boston Medical Movement Disorder Clinics / Tourette Syndrome Clinic: These clinics treat children with ataxias, chorea (including Sydenham’s chorea), drug-induced movement disorders, dystonias, paroxysmal dyskinesias, psychogenic movement disorders, tremor, Tourette syndrome and other tic disorders. One increasingly promising treatment for Parkinson’s disease is deep brain stimulation. Our Centre provides support services to people with Parkinson's Disease, with our support staff to form a comprehensive medical management team. physician connection line - specialist consults The communication center facilitates physician-to-physician consults - connecting referring physicians with specialists at Dayton Children's to confer about a patient. Functional disorders also can occur in children with other neurological problems and make an existing movement disorder worse. It is a Parkinson’s-plus syndrome. This online appointment request is a secure and confidential area. The nursing staff performs suture removals, wound care, and provides pre and post Clinic Services. 8) Huntington disease (G10) Other. Dr Zelko Matkovic Referral Guidelines. b) MRI brain without contrast (G25. Referral Instructions. Movement Disorder Evaluation. We don t rest until you do DIAGNOSTICE SLEEP PACKAGEComplete Sleep Care:1. Jun 10, 2019 · Neurology Clinic Referral Guidelines for MAP Handbook. Please do NOT refer the following patients to Neurology clinic: Disability evaluations; Patients with suspected carpal tunnel syndrome (Refer directly for EMG) Chronic non-specific pain, such as complex regional pain syndrome, fibromyalgia, phantom limb pain, etc. Patients may learn about the clinic and services provided by attending educational meetings sponsored by Parkinson Society British Columbia (PSBC), from allied health professionals in the Mar 15, 2017 · Find An Expert Movement Disorder Specialist in Baton Rouge March 15, 2017 2:14 pm. 9753 ext. Referring a Patient If you have any questions or have any problems in reaching our physicians, please call 502-588-6000 and the referral line professional will personally address your request. SoCal MDS - In-Clinic Treatments for Movement Disorders Sleep Disorder Center Referral Form Wethersfield - 1260 Silas Deane Highway Suite 101 Bloomfield –533 Cottage Grove Road Please fax to (860) 545-5080. Sleep Disorder Center We Help Patients With Poor Sleep Habits and More Serious Underlying Medical Conditions The Sleep Disorders Center at Nationwide Children's Hospital and our Sleep Medicine Clinics assist primary care physicians and specialists with the diagnosis and treatment of infants, children and adolescents with sleep problems. Post-Sleep Study Clinic Consultation and Treatment Selection with Sleep Medicine Specialist. Review of Human Genome, Stroke Risk Genes. The first and most important role of our physicians is to provide you and your family with exceptional neurological care for a wide range of movement disorders. Please let your patient know that you are requesting a sleep disorder evaluation or a sleep study. It is the second-most common form of dementia after Alzheimer’s disease. Fax back to: (204) Neurology assessment. Paediatric Neurology Referral Form In order to help us better meet the needs of the children referred to our Paediatric Neurology clinic, we require that the following information be completed. Our Parkinson's and Movement Disorders Center is committed to providing A physician referral is not required to make an appointment. Dent and Gallagher. Care & Discharge Planning (48/6) is a pro-active, integrated approach designed to prevent functional decline and in-hospital co-morbidity. Contact Provider & Office. 0) Download the Referral Form. Get in touch with our neurologists to find the best ADHD treatment available for your specific needs. By ensuring ongoing support, effective management and best practice treatments we aim to improve the health and well-being of our patients and the community. unc. I never found a neurologist who would connect Neurontin as the mechanism. MBS. Please be prepared to provide the following All recent medical records; Recent MRI scans; Pathology slides Online Physician Consults for Brain Tumor Cases Movement Disorders & Neurorestoration Program Department of Neurology (352) 294-5400 Fax: (352) 627-4295 Patient Appointment Confirmation Patient name: At the request of your physician, you have been scheduled to see a Movement Disorder specialist with the University of Florida’s Department of Neurology. Brampton Sleep Clinic Periodic Limb Movement Disorder Other IF YOU WOULD LIKE US TO SEND YOU MORE REFERRAL FORMS SLEEP DISORDER REFERRAL FORM Outpatient Programs PRIME more information on this program Referral Form Referral Guideline Day Hospital The Day Hospital program provides assessment and rehabilitation services to promote healthy living for seniors in the community and reduce potentially preventable hospital admissions. Overview This clinic is dedicated to the medical management and education of patients with a wide variety of movement disorders including dystonia, myoclonus, chorea and tics. phone: 937-641-4385 toll-free: 1-877-855-7337 fax: 937-641-3131 hours: Monday All of the information you need to confidently refer your patient to one of our specialty clinics. The Children’s Mercy Comprehensive Movement Disorders and Spasticity Clinic recommended an intrathecal baclofen pump be implanted, and now Josie is on the road to recovery. Members of the Movement Disorders Center are experienced clinicians in the movement disorders field. If you or your physician suspects you have Parkinson's disease or another movement disorder, In addition referrals are provided to rehabilitation specialists in Physical Therapy, For your convenience, download the outpatient clinic form. Referrals What Type of Referral Is This? Patient Wanting To Make A Self-Referral; Physician Wanting To Make A Referral; Patient Self-Referral. 542. Movement ABC Assessment Clinic. 81) Parkinsonism (G20) Multiple sclerosis (G35) Alzheimer disease (G30. How to Become a Patient Contact your physician This can be your family doctor, your internal medicine physician, your neurologist, or any physician who feels you may have a movement disorder. This form was commissioned by the Colebrook Clinic and created by NERD BC - with thanks to both. phone: 937-641-4385 toll-free: 1-877-855-7337 fax: 937-641-3131 hours: Monday At the Mid North Coast Sleep Clinic, we are committed to providing easy to access, affordable diagnosis and treatment for suffers of Sleep Apnoea. 4880 or 906. . 4 million people in the U. 449. Click here to download the referral form. Fax the completed form to the appropriate clinic (see fax numbers for each clinic above). OHIP will only cover requests for sleep studies on the order of a physician; Referrals for sleep studies are not accepted by other professional bodies. In addition to this form, it is important that you bring a complete list of current medications you are taking, doses, and times for each medication. Our centre has been providing care for patients with Parkinson and movement disorders since first established in 1990. Today’s date: Requesting Practitioner: Office Address: • An itemized invoice will be sent each month. These forms are available to download for your convenience in fillable PDF format. They may also seek a referral if they have an interest in participating in research. This clinic is affiliated with these UCSF Memory and Aging Center’s specialty services: Neurogenetics Cognitive and Movement Disorder Clinic; Huntington’s Disease Clinic Cognitive Disorder Movement Disorder CNS immune Disorder Cognitive impairment (R41. Movement Disorder / Parkinson Disease Insurance authorization or referral as appropriate Clinic data to support the issues you want to address Comprehensive Stroke Care Centre. Rajeev Kumar, MD. 3%, a rate higher than both the prevalence of Huntington disease and restless leg syndrome in the same clinic. If you are a patient with Parkinson's disease, dystonia, or tremors and would like to be seen but are having difficulty obtaining a referral from a primary care physician or a neurologist, please call our office at (318) 212-8176 for more information on This group of experts includes a neurologist, specifically trained in movement disorders, an APN, a neurosurgeon, neuropsychologists, social worker, physical, occupational and speech therapists and a specialty specific nursing staff. The National Ataxia Foundation is not responsible for the content or availability of these web Read More Head, Movement Disorders Department of Neurology Cleveland Clinic Cleveland, Ohio USA . ) If you are a physician and would like to refer a patient, please use this referral form. Appointment Request and Clinical Triage Form Movement Disorder: Please FAX to us pertinent recent clinic notes, hospital summaries, other lab reports and Referral Form, Sleep Disorders Unit, The Prince Charles Hospital Heart and Lung Clinics Author: Heart and Lung Clinics, The Prince Charles Hospital, Metro North Hospital and Health Service Subject: Referral form to the Sleep Disorders Unit, The Prince Charles Hospital. Referrals to the Sam and Ida Ross Memory Clinic from the client’s physician are required. ) Program: Movement Disorder Clinic Our specialists are here to assist community physicians and specialists with consultation and referral services. We diagnose and care for patients with these movement disorders and (HDSA) earned the designation the USF Health Huntington Disease Clinic a Center of  with Parkinson's through the Jeff and Diane Ross Movement Disorders Clinic and with Referral forms can be found on each clinic or program's page above. Call the Business Office with billing related questions: 800-447-6424 (US and Canada) At three-years-old, a rare condition damaged Josie’s brain, impacting her ability to speak and leaving her with a severe movement disorder. ( Treatment Follow-Up Circadian Rhythm Disorder Mood Disorder Nocturnal Panic [2 Fibromyalgia Cl Obesity Cl Impotence Cl Head injury Tourette's [2 Parkinson's Narcolepsy Parasomnia Nocturnal Seizure Excessive Daytime Sleepiness CPAP Titration Restless Legs Syndrome Periodic Limb Movements Self Referral Form: When you are interested in working with a board certified sleep doctor, but do not have a direct referral from a provider, this is the form you need. Please note: It is especially important to use the correct private fax number for referrals, as clinics and doctor's offices are not always in the same place. Your appointment date and time are as John Growdon, MD, formalized Dr. 790 Bay Street REASON FOR REFERRAL: Rhythmic Movement Disorder title = "Phenotypic commonalities in familial and sporadic Parkinson disease", abstract = "Background: Parkinson disease (PD) is a clinically well-documented neurodegenerative disorder. Deep Brain Stimulation as a Treatment for Movement Disorders. Refer a Patient Online. To visit the Movement Disorders Clinic, a referral from either a family doctor or another specialist is required. Please fax referrals to 604-822-7866. Movement Disorders Center. There is no age limit for referral of clients, except that they must be adults and meet the appropriate reasons for referral which include: assessment and/or management of dementia or abnormal behaviour due to disorders such as Alzheimer’s disease, frontotemporal dementia, and Appointments Welcome to the Parkinson’s disease and Movement Disorders Center! To schedule appointments please call 913-574-0038. Who can make a referral: We currently are accepting requests for new patient appointments from outpatient clinicians to whom we will send a report and recommend appropriate follow-up care with us or elsewhere. Rare Disorders The Movement Disorders Clinic specializes in the diagnosis and treatment of a variety of rare disorders characterized by involuntary movement. July 2018) Patient Label Here Chronic Migraine Or Movement Disorder Consultation Request for Botox Injection Treatment Consideration At the Mid North Coast Sleep Clinic, we are committed to providing easy to access, affordable diagnosis and treatment for suffers of Sleep Apnoea. The Parkinson's Disease and Movement Disorders Center at BIDMC brings together an exceptional team of multidisciplinary providers to offer personalized care and the most advanced treatment to patients with Parkinson's disease, Huntington's disease, dystonia, tremors, atypical parkinsonism, and various other movement disorders. Lafayette area referral form for IU Health Arnett, IU Health Frankfort, IU Health White Memorial (or call 800. A condition known as functional neurological symptom disorder, sometimes called conversion disorder, can cause any of the movement disorders described above, even when no neurologic cause or condition can be identified. To be referred, a physician must submit the Child and Youth Specialized Psychiatric and Mental Health Services Intake Referral Form. 9) CNS Immune Disorder Evaluation. How to Book a Sleep Study. REFERRALS TO UNIVERSITY OF FLORIDA PHYSICIANS Referral Source Program Department Contact Movement Disorder Outpatient referral process to Bentley Hospital ALL GP & Private Specialist referrals to: Community Rehabilitation Diabetes & Endocrinology Gastroenterology / ASI Geriatrics (inc Memory clinic, Parkinsons / Movement Disorder clinic) Gynaecology MUST come via CRS: CRS Secure messaging Send electronic CRS form via Clients are expected to complete weekly homework in order to apply the skills that are learned in therapy in their everyday life. Welcome. Please direct any questions about the Interdisciplinary Parkinson Disease Clinic to the Center Coordinator, Jessica Shurer, LCSW, at (919) 843-1657 or jshurer@neurology. Clinic. Location. Comprehensive Movement Disorders · Gastroenterology/Hepatology  Epilepsy; Movement disorders; Dizziness; Migraine. Academic professionals in our group have full time University faculty appointments. Fax completed form and records to. Semi -Urgent. 6007. Your care team also includes a nurse specialist who helps arrange treatment and   Getting help from the MUSC Health Movement Disorders Program. Movement disorders can be relentlessly progressive and disabling conditions. Under the leadership of medical director Dr. Information entered and submitted is confidential. Must be included for sleep study: clinic note MUST contain indication for study and a detailed sleep history. To visit the Movement Disorders Clinic, a referral from   To be seen at this clinic, you will need to have had a referral from either your family doctor or another specialist. Physical exam (neuro, ENT, CV, weight, VS, and neck circumference), and functional limitations related to sleep disturbance. The NeuroMedical Center’s Movement Disorder Program has captured the world’s attention for providing expert diagnosis, treatment, and life-changing results for patients suffering with Parkinson’s disease (PD), essential tremor (ET), dystonia, and more. Our director, Dr. Please allow up to 48 hours for processing of your referral. About the Clinic. Referral Forms: ambulatory care and community services referral form instructions Movement Disorders Program Client has a diagnosis of Parkinson’s Disease or Parkinsonian Disorder and requires multidisciplinary strategy training and/or review by Neurologist and/or Clinical Nurse Consultant. Specialist Consulting Clinics Referral Form 229 KB  Movement Disorder Clinic This clinic has been established to provide the patient should still be seen at this facility please indicate why on the referral letter. Using a list of referral key words, secretaries review all incoming referrals to identify referrals for 'probable movement disorder' and immediately book these patients at the movement disorder clinic. HSC. Referrals must be addressed to a named specialist or the Head of service, listed at the top of this page. For your convenience, download the outpatient clinic form (PDF). In order to be referred to the facility, a physician currently responsible for the care of the patient must initiate the referral using the steps below The Duke Department of Neurology offers exceptional patient care for patients with conditions affecting the brain and nervous system. Referring Health Care Provider Signature: Date: This facsimile is directed in confidence and is intended for use  FHA Movement Disorders Clinic Referral Eform 2015. The neurologists at UofL Physicians – Parkinson’s Disease and Movement Disorders are highly trained in diseases that affect physical movement, such as Parkinson's disease. • Payment terms are net 30 days. Twenty years later, the unit combined with the Brigham and Women's Hospital Movement Disorders Clinic (part of the Partners HealthCare System) to form the Partners Parkinson Disease and Movement Disorders Center. If you prefer, you may call 800-888-5533 to refer patients via the UK-MD phone line. Millions of Please note there is an Expedited Referral Form for patients being referred for  The Movement Disorders Unit at Mass General sees patients from around the to treating patients with Huntington's; Dystonia Clinic: a regional referral center for Movement Disorders Clinic (part of the Partners HealthCare System) to form   Movement disorder specialists at MUSC Health provide advanced treatments, including in downtown Charleston, we also provide care at our Mount Pleasant clinic. Please be advised incomplete information or need for clarification may delay the process. Your team is highly-trained and works together to provide quality care, from diagnosis to treatment. • . we require a written referral from your physician to make an appointment. This is an outpatient clinical rotation that provides the opportunity to focus on neurodegenerative disorders such as Parkinson’s disease, as well as a variety of other movement disorders. 0) Tremor (R25. Clinic consultants are listed on every clinic page. The clinic is also appropriate for healthy people with no diagnosis who seek genetic testing to determine future risk for an inherited neurodegenerative disease. This will ensure that your patient is getting the specifc services that they need. Sleep related movement Referral Downloads: Sleep Study Referral . The UNC Movement Disorders Center within the UNC Medical Center is a multidisciplinary specialty group dedicated to providing individualized, compassionate and comprehensive care to our patients. CBT is used in this clinic for disorder-specific group treatment of social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and major depressive disorder/dysthymia. Referral Clinic: Neurology - Movement Disorder. For new patients we will need a reason for your evaluation and if possible pertinent records for the past year and any neurological tests like brain MRI that may have been done. 1900 116th Ave NE Ste 200, Bellevue,WA 98004. Hyperkinetic movement disorders include tremor, chorea, ballismus, athetosis, myoclonus, tics, and dyskinesias. MBS* Head of Unit. Box 208018New Movement Disorder (eg Parkinson’s disease, tremor, Huntington’s, involuntary o movements) Multiple Sclerosis o o Spasticity o Neuromuscular (eg neuropathy, muscle disease, ALS) Stroke / neurovascular o Other (please specify) _____ Is referral for consult only? _____ Or ongoing care? _____ Is the patient under the care of a neurologist? A condition known as functional neurological symptom disorder, sometimes called conversion disorder, can cause any of the movement disorders described above, even when no neurologic cause or condition can be identified. The team includes movement disorder neurologists, nurses and research staff who work together with our support staff to form a comprehensive medical management team. Winnipeg, MB R3A 1R9. Tel : (425) 502-8075 Fax : (425) 531-7186 Sleep and Health Medicine at Everett location Page 2of TIA/Stroke/Neurology Clinic Community Referral Form Form# 5285 (Rev. Physician referrals and self-referrals: To schedule a new or follow-up appointment at the The Center for Movement Disorders and Neurorestoration offers the highest level of integrated, interdisciplinary care for patients with movement and neuropsychiatric disorders. Submit an online appointment referral form or call our 24-hour referring  The Movement Disorders Unit at RMH is dedicated to providing quality care for We accept GP and specialist referrals for this service. Room GE-217. Our Centre provides support services to people with Parkinson's Disease, Huntington's disease and other movement disorders. Through focused collaborative efforts, we are integrating clinical discoveries with newly identified radiographic and biological To learn more about the Memory Disorders Clinic at MUSC Health or to schedule an appointment, please call 843-792-3223. We accept referrals from GP’s by e-referral and secondary care clinicians by letter to the address below. Our clinic is located in the Duke Health Center at Morreene Road. MBS-billed services require a current referral. Lewy body dementia affects behavior, thinking and movement. We also conduct cutting-edge basic, translational, and clinical research, and train the next generation of leaders in neuroscience. Phone: (860) 696-2820 *6804* 6804 Assistance in/out of bed Oxygen _____ LPM Incontinence Dementia Needs interpreter _____ Aide required at home PATIENT REFERRAL FORM Sleep-related movement disorder ( ) Congestive heart failure UNCONTROLLED seizure disorder, heart failure, coronary disease, or chronic UT Health East Texas Movement Disorders Center When facing a movement disorder, you want the most skilled specialists. Luke's movement disorders program, which operates the multidisciplinary Movement Disorder Clinic. Please fax the completed form to 519-685-8350. Please read referral criteria at the end of this form before completing it. Assessment for Autism Spectrum Disorder » Poor functional communication A large movement disorder clinic estimated the prevalence of psychogenic movement disorders to be 5. New patients are encouraged to email whenever possible to receive intake questionnaires and additional useful information. Once the form is completed, you will receive a Some of the most common types of movement disorders include: Parkinson’s disease – This is the most common form of Parkinsonism, which is a group of motor system diseases. 0) Our neurologists provide stroke treatment, consultations and ongoing care and diagnostic services that identify, characterize and treat neurological problems like epilepsy and seizure disorders, stroke, movement disorder (Parkinson’s disease, tremor), dementia, multiple sclerosis, headaches, neuromuscular diseases (neuropathy, myasthenia Essential referral information for Movement disorders including Parkinson's Disease (PD), dystonia and essential tremor referrals TSH results for tremors If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. Dayton Children’s offers a variety of neurology services and programs. Provide your patient with a 12 month referral to see the specialist of your choice at the requested clinic. N/A Referral Form (not mandatory) Letter Campus. Suspected TIA or stroke in the past 1-3  Our team runs a fortnightly Parkinson's (PD) and movement disorders clinic. The most common examples of this kind of disorder are: Read about the treatments Southern California Movement Disorder Specialists offers. Western Hospital Footscray Contact Details. The Movement Disorders group is a unique, Canadian integrated neurology/neurosurgery research and treatment facility that offers a multidisciplinary approach to movement disorders, including speech and language pathology, neuropsychology, and physical therapies. We will contact your patient to complete the registration process and schedule an appointment. 2019 Update by Esther Cubo, MD, PhD and Mark Guttman, MD, FRCPC. The neurologists at UofL Physicians Parkinson's Disease and Movement Disorders center are highly trained in diseases that affect physical movement and have  Salem Health neurology is committed to helping people diagnosed with brain, Your doctor may call our office if they need one of our referral forms — or you  Salem Health neurology is committed to helping people diagnosed with brain, spinal cord Your doctor may call our office if they need one of our referral forms — or you may Salem Health Specialty Clinic — Neurology, Pain, Palliative Care The Northwestern Medicine Parkinson's Disease and Movement Disorders Center at The Northwestern Medicine Movement Disorders Neurogenetics Clinic is one of a brief contact form and a nurse from the Parkinson's Disease and Movement Pay a Bill · Insurance Information · Get a Second Opinion · Refer a Patient  Winnipeg Multiple Sclerosis Clinic. Movement Disorder Services Offered GENERAL SERVICES. For information on the clinic and its services, or to prepare for your appointment, please visit the patient section of the PPRC website. We do not provide Please see your GP if you believe you would benefit from a referral to this clinic. Pre-Sleep Study Clinic Consultation with Sleep Medicine Specialist. 8 years (median) following diagnosis for APD, or 3. The division of Parkinson's Disease and Movement Disorders consists of a multidisciplinary group of neurological specialists who provide comprehensive specialty and subspecialty care. Restless legs may limit the time the person is able to sit still in an automobile, airplane, or in a business meeting without standing or moving around. The clinic receives referrals from primary and secondary care, predominantly from Parkinson's, PD) is the most common movement disorder, but other forms of  For referrals to any of the Neurology Clinics we ask that you please contact the specific clinic and This information can be easily filled out in our referral forms:. Learn more about the clinic at Dayton Children's Hospital. Diagnosis, treatment and management of disorders related to balance or dizziness; Advanced testing including Videonystagmography (VNG), Gans Sensory Organization Performance (GSOP), Rotational chair, Vestibular Evoked Myogenic Potentials (VEMP) and Auditory Brainstem Response (ABR) Ambulatory Care Antepartum Care at Home Program Antepartum Care Services Antibiotic Therapy Anticoagulation Management Bone Densitometry Breast Health Clinic Cardiac Rehabilitation Cast Clinic Chronic Pain Clinic Health Information Resource Centre Computed Tomography (CT) Continence Clinic Diabetes Education Gestational Diabetes - Diabetes in Pregnancy Diagnostic Cardiology Early Pregnancy Sleep Disorders Clinic. Online. Our movement disorder experts partner with you to create a treatment plan tailored to your individual needs and goals. 1) Ataxia (R27. One neurologist put on my referral to a movement disorder clinic. We will help you book a sleep study timely and at a suitable sleep clinic - call us at 905-409-0688 Referral Date: _____ Limb Movement Disorder ☐ Shift Work What is the Alberta Referral Directory? The Alberta Referral Directory (ARD) is Alberta Health Services’ designated system of record for referral information. Movement Disorders. To refer a patient, please complete our online physician referral form and fax all related clinic notes and diagnostic reports to us. For any questions or concerns please call our clinic at 203-785-4085. A referral to the Specialty Clinics at UP Health System - Marquette can be made by calling the clinic at 1. 1815, or by completing the Specialty Clinic Referral Form. With over eighty faculty representing every neurological subspecialty, Vanderbilt Neurology is a national and international referral center for state-of-the-art neurological care, education, and research. 2. Functional disorders also can occur in children with other neurological diagnoses and make an existing movement disorder worse. The ARD eases the complexities of the referral process by eliminating the need to search, update and publish documents in multiple places throughout the province. Patient . Suspected or confirmed neuromyelitis optica spectrum disorders (NMOSD). It affects an estimated 1. For your convenience, we have created a standard referral form that you are welcome to print as needed. GP Referral Form. Huntington’s disease is an autosomal dominant neurodegenerative disorder (therefore, each child of an affected parent has a 50% chance of developing the disease). This disorder happens when a buildup of Lewy bodies, a brain protein, leads to worsening dementia. If you haven't been seen for the past year, the   Our clinic is staffed by two specialist Movement Disorders Neurologists in addition to a Parkinson's nurse. If referring to the clinic with suspected seizure – also send a referral for an EEG to Suggested GP Management - Referral to Neurology dept. The form is designed to identify the pertinent information needed to process the referral efficiently and to be sure that your Mayo Clinic is an internationally recognized leader in addressing the mechanisms of movement disorders associated with neurodegenerative disease and Parkinson's disease. The Royal Melbourne Hospital Comprehensive Stroke Care Centre is an internationally renowned academic unit that caters for approximately 1200 inpatients a year and runs a world-leading research program including acute therapy research and clinical trials. You will be notified of the appointment date and time once it has been scheduled. The Movement Disorders Clinic provides access to doctors specializing in diagnosing and treating movement disorders for The clinic also provides opportunities to participate in research related to movement disorders. 4880, Fax: 906. The initial evaluation includes a thorough medical history and physical examination, as well as additional tests, if needed. Reason for Referral Must check one circle from the choices below. Urgent TIA Clinics, Urgent Neurology Clinic, EMG & Nerve Conduction Testing, Pediatric Neurology Clinic, Pedi… for scheduling the movement disorder clinic. Pediatric patients age < 18 Movement Disorders Introduction and Goals. We offer the latest diagnostic and state-of-the-art treatment options for the following conditions: Parkinson's disease Life-Changing Care for Movement Disorders. Treatment options include: Medication: We can help you manage the symptoms of your movement disorder with medication. Delaram Safarpour, a neurologist and specialist in movement disorders, is part of our nationally recognized Parkinson's disease Referral: To become a patient, please ask your doctor for a referral. Department-specific referral forms If referring a patient to one of the areas below, complete and submit the department-specific form only. The Movement Disorder Program (MDP) is a specialist outpatient program that provides client centred assessment, treatment and advice to assist people who have Parkinson’s or Parkinson’s related disorders. The clinic has extensive experience with botulinum toxin injections for the treatment of focal dystonia and hemifacial spasm. He is also a fellow in the American Academy of Neurology. Download a referral form at the bottom of this page to take to into your doctor for a sleep study. George Plotkin, PhD, MD, the UT Health East Texas Movement Disorders Center has gained a reputation for excellence. Referral. Referral to Developmental Co-ordination Disorder Pathway. Another form of restless legs is periodic limb movement disorder (PLMD). We work with you to monitor the ongoing effectiveness of your Referral Clinic: Neurology - Movement Disorder Referring Health Care Provider Signature: Date: This facsimile is directed in confidence and is intended for use by the individual or entity to which it is it specifically addressed. Keywords Reason for Referral P AVM/AVFistulasP Movement Disorder Clinic P Cartoid Artery Stenosis P Moya - Moya Disease P Cerebral AneurysmP Neurosurgery - Brain P Epilepsy ClinicP Neurosurgery - Spine P General Neurology Clinic P Sleep Clinic P Headache ClinicP Vertebral Stenosis P Memory ClinicP Other: _____ Once again, the KGH Auxiliary at the Kingston General Hospital (KGH) site of Kingston Health Sciences Centre (KHSC) has shot past its fundraising goal for its annual Teddy Bear Campaign, raising more than $32,600—well beyond its $25,000 target—to purchase carbon dioxide monitors for the KHSC To refer a patient to our DBS Clinic, please fax a referral and relevant notes to 720-848-0015. Deep brain stimulation is a well-established treatment option for patients who are dealing with a range of movement disorders, such as essential tremor, parkinson’s disease, epilepsy, and dystonia. For diagnosis- refer to Movement Disorder Diagnostic Clinic, Box Conditions We Treat. SLEEP DISORDER ASSESSMENT REQUISITION FORM . Submit an online appointment referral form or call our 24-hour referring physician service, MEDULINE, at 800-922-5250. Phone: 8345 6490. The UCSF Neurogenetics Cognitive & Movement Disorder Clinic seeks to serve the needs of adult patients with known neurogenetic conditions, as well as patients with neurological conditions of suspected, but unconfirmed, genetic or familial etiology. Patients may be seen as new referrals or for follow-up care. The Djavad Mowafaghian Centre for Brain Health builds on UBC's impressive legacy of brain research and brings together experts in the fields of neuroscience, neurology, psychiatry, and rehabilitation in a hub for training, research, and clinical care. 6 years for non-APD. Movement disorders such as dystonia or spasms are neurological conditions, which means they are caused by problems in the nervous system. S. a) Consultation for: Multiple sclerosis (G35) Neuromyelitis optica (G36. Our multidisciplinary center is staffed by movement disorder specialists, including adult and child neurologists, a neuropsychiatrist, neuropsychologists, research nurses, occupational and physical therapists, and clinical and research fellows. To refer a patient, you have the option of contacting us by fax, online, or by phone: By Fax. It provides emotional support, counselling and referral to other health and … Movement Disorders Program Brochure (PDF, 432KB) Parkinson’s Victoria website. The Cabrini Parkinson's Program specialises in working with people with Parkinson's and Download our Parkinsons outpatient program and referral form Specialist neurologists implement “advanced therapies” for Parkinson's at Cabrini. Overnight Sleep Study in Sleep Lab. The Wake Forest Baptist movement disorders team provides expert care and treatment to patients with neurological conditions that cause impaired movements, such as Parkinson’s disease, dystonia, and essential tremor. Sleep Breathing Disorders (Obstructive Sleep Apnea, Central Sleep Apnea Syndrome, Cheyne Stokes Breathing, Hypoventilation Syndromes) Hypersomnia / Increased Daytime Sleepiness (Idiopathic, Post- traumatic, Narcolepsy, Other causes) Insomnia; Leg Movement Disorder (Restless Legs Syndrome, Periodic Leg Movement Disorder) Referral from a physician or school board is required to access CHEO Urgent Mental Health Services. We are a world center for Parkinson's disease treatment and research. Parkinsonism is a hypokinetic movement disorder, with overall paucity of REFERRAL REASONS ASSESSMENT TYPE Cognitive Impairment Inpatient General Outpatients Psychotic Disorder Affective Disorder SPECIFIC SERVICE Functional/Behavioural Change HD Clinic Predictive HD Clinic Movement Disorder Epilepsy Psychosurgery Assessment Referral Criteria for: Neuropsychiatry Clinic Referral Criteria What are the age criteria ? Between the ages of 6 -18 years old What are the gender criteria ? n/a Who can refer? A G eneral P ractitioner, Medical Specialist, Neu rologist or Pediatrician can make a referral Is there a form that needs to be filled out? Physician Referrals. Mailing AddressDepartment of NeurologyYale University School of MedicineDepartment of NeurologyP. Advanced Treatment and Support for Movement Disorders at BIDMC. The clinic coordinator will mail you a new patient information packet with forms that need to be  The Wake Forest Baptist movement disorders team provides expert care and treatment to patients with neurological Movement Disorders Clinic Coordinator. Once the quick one page form is completed, send it back to the Alaska Sleep Clinic of you choice, Sleep and Health Medicine at Bellevue location. Rocky Mountain Movement Disorders Center. REASON FOR REFERRAL: Snoring Sleep Apnea Insomnia Tel. If this is a request for subspecialty neurological consultation, including a “second opinion,” please see below: For Stroke, Headache, and Neuromuscular Clinics, fax the referral form to 434-924-9068 For MS, Movement Disorder, and Memory Disorder Clinics, fax the referral form to 434-982-0606 … To refer a patient who resides in the United States, you have two options: Use MD Link, our secure portal for physicians. 1 While recent imaging research has pointed to an abnormal network of neuronal activation, 2 the mainstay of treatment for these REFERRAL REASON ASSESSMENT TYPE Cognitive Impairment Inpatient General Outpatients Psychotic Disorder Telehealth BCV Affective Disorder SPECIFIC SERVICE Functional / Behavioural Change HD Clinic Predictive HD Clinic Movement Disorder Epilepsy Psychosurgery Assessment Neurological Disorder ECT REFERRAL FOR SLEEP STUDY ONLY (Please complete sections 1–5 below) OR CONSULTATION AND SLEEP STUDY, IF INDICATED (Please complete sections 1–3 below) • Has the referred patient had a previous sleep study? Yes No • If yes, please provide the date of the last sleep study: Location: HISTORY AND PHYSICAL INFORMATION Oshawa Clinic Centre for Sleep Medicine 13 Charles Street, Oshawa, Ontario, L1H 4X5 Phn# (905) 721-4052 Fax# (905) 721-4054 SLEEP LAB REFERRAL REQUISITION A single secretary is now responsible for scheduling the movement disorder clinic. Periodic Limb Movement Disorder (PLMD) A sleep disorder which involves repetitive movement of the limbs during sleep and may be associated with arousal activity in the brain during sleep. Wassim Assaf having had worked at various hospitals throughout his career realized just for persistent of an issue this was. 1) Neuromyelitis optica (G36. Patients will be contacted by our DBS Intake and Access Coordinator to schedule an appointment. edu. (Please close this window or tab to return to your search results. The Clinic is staffed by neurologists, neurosurgeons, registered nurses, registered practical nurses and clerical personnel. 0) Dystonia G24. Understand our approach to managing movement disorders and the treatments we prescribe to help our patients. OSF HealthCare Illinois Neurological Institute's (OSF INI) Parkinson's Disease and Movement Disorders Center is the only facility in Central Illinois that provides   1) FAX letter or referral form marked URGENT with details to 902-473-4438. Children’s Community Therapy Service. 702. Thank you in advance for your assistance. 562. 820 Sherbrook Street. SLEEP AND ALERTNESS CLINIC. 1. ; Download our referral form, complete it and fax it to the clinic. Bradford Worrall, MD and researchers in the Department of Neurology, seeking to better understand how our genes contribute to stroke risk, have completed what is believed to be the largest and most comprehensive review of the human genome to identify genes that predispose people to ischemic stroke, the cause of approximately 85 percent of all Neurological and Specialty Clinics Links Disclaimer NAF strives to provide the most accurate and validated information to the Ataxia community. We are a team of professionals dedicated to providing optimal patient care. Rajeev Kumar is one of the world’s foremost experts on movement disorders, with unparalleled experience and expertise treating and researching Parkinson’s Disease, Huntington’s Disease, Dystonia, and many other debilitating movement disorders. Fill out the UCSF Referral Form. ****LP Clinic Appointments****To make a referral to the lumbar puncture please fill out the referral form and fax it to 203-785-3732. She was strongly recommended to be active and especially increase walking, and encouraged to continue her chiropractic Through a continuous focus on research and discovery, our movement disorder specialists keep up-to-date on evolving movement disorder therapies as new medications and treatments are tested and approved. Movement disorders are neurological diseases that affect control over the way the body moves. SFMatch registration for applicants opens April 2015 and match deadline for programs is held in September 2015. Overview The Neurosciences Clinic provides outpatient consultation and care to neurosurgical and neurological patients. Referral criteria. We are relocated at the Kaye Edmonton Clinic, operating as a joint initiative involving the University of Alberta and Alberta Health Services. Checking more than one box will result in a delay in scheduling and need for a new referral form to be completed. Whether you have a diagnosis or you are searching for answers, it is critical to find neurologists who specialize in the diagnosis and treatment of these conditions. Clients attend 1- 2 One neurologist described me with ballism, which means twitching and jerking. 800. If you have an established relationship with one of our physicians, you may call them directly to refer a patient. a) Consultation for: Parkinson’s disease (G20) Tremor (R25. Download a referral form and fax us the completed document. SNORE Australia is a medical provider partner with Air Liquide Healthcare Sleep Diagnostics and Healthy Sleep Solutions. Movement Disorder Clinic Description. However, the mechanism or mechanisms of its phenotypic expressions are still unknown. When you suffer with a movement disorder caused by a neurologic illness, physical functioning and motor control can be severely impaired. If this is a request for general neurological consultation, fax the referral form to 434-924-9068. Fax: 8345 6856 (Note: For PCP referrals, we would prefer that neurology notes be sent as well. Refer a Patient . Subsequent to specialist diagnosis of PD, Sinemet TM 25–100 monotherapy (containing 25 mg of carbidopa and 100 mg of levodopa) 8 was prescribed, and the patient was referred for physical therapy at a movement disorder clinic. For those with APD, referral was predominantly to enable access to DAT (49%), while for non-APD, referral was largely for diagnostic purposes (41%). You will be contacted with further instructions. Emory Clinic neurologists draw on research and experience to treat neurological   The movement disorders service sees patients with conditions or symptoms including abnormal involuntary movements that lead to shaking, jerking, or twisting  Are you a healthcare provider who needs to refer a patient to a specific service line? Comprehensive Movement Disorders · Gastroenterology/Hepatology  View the UChicago Medicine physicians specializing in Parkinson's disease and movement disorders. movement disorder clinic referral form