Request for Referral / Consult Submitted to our Bettendorf, Kimberly Road Location

Please fax or send electronically:

• Fax: 563-355-9077
• Online: UI CareLink and CareEverywhere 

Please include the following:

• Physician Clinical Notes regarding diagnosis (most recent three years)
• Previous Oncology Clinical Notes
• Surgical Evaluation (Pre- and Post- Operative)
• Reports (Radiology, Surgical Pathology, Bone Marrow, Molecular Testing, Genetic Testing, etc)
• Lab Reports (most recent three reports) Treatment History (Chema, Radiation, Immunotherapy, etc)

• Surgical Pathology and/or Bone Marrow slides related to Diagnosis
• Please Expedite by sending via same-day courier or overnight express.
  • FedEx Account Number: 432669661
  • Address: 
    University of Iowa Health Care
    Dept. of Pathology
    5222 RCP
    200 Hawkins Drive 
    Iowa City, IA 52242

• Please push electronically within 24 hours using Inteleshare/Ambra
• If you do not have access to push electronically, you may load images on a disc in DiCom format and send via Fed Ex.
  • FedEx Account Number: 432669661
  • Address:
    University of Iowa Health Care
    Clinical Cancer Center 21602 PFP (Medical Records)
    200 Hawkins Drive
    Iowa City, IA 52242
• Include all imaging relevant to diagnosis
  • CT Scans
  • PET/CT Scans
  • Ultrasounds
  • Nuclear Medicine Tests
  • Mammograms
  • MRI Scans

If you are requesting for your patient to see genetic counseling, please complete this form upon the referral submission.

If you are requesting for your patient to be referred to our neuroendocrine, please complete this form upon the referral submission.