Upstate Medical University welcomes the opportunity to partner with you in caring for your patients. Below is a list of frequently used forms you may need to prepare and coordinate your patient's care prior to hospitalization.

Forms used at both University and Community Hospitals

• Consent for Diagnostic, therapeutic, invasive or surgical procedures (40580RP)
• Consent for Transfusion (41485RP)
• Department of Radiology Outpatient Exam Order (F82832RP)
• Diabetes Self-Management (F83294RP)
• Discharge and Referral Orders (40630RP)
• History and Physical (40981RF)
• Lung Cancer Screening Order (F83911RP)
• Obstructive Sleep Apnea (OSA) Screening Tool (Adult) (F82353RP)
• Outpatient Nutrition Referral Form (Pediatrics) (F82173RP)
• Outpatient Nutrition Referral Form (Adult) (F82173)
• Perinatal Center Consultation Request (F86125RP)
• PRE-OP Orders: Orthopedic (F83811RP)
• Progress Notes (41330RP)
• Women's Health Services Patient Referral Consult (F83413)