Referral Information for Sites Contracted for Telehealth (Provider-to-Provider)
Our provider-to-provider telehealth program connects physicians and their patients with UC Davis Health specialists. Since its inception, the program has provided real-time consultation services in nearly 50 specialties. More than 200 clinics and hospitals, typically located in rural areas, have benefited from the innovative program.
Telehealth Resources
Providers at sites contracted for telehealth services, historically through the Center for Health and Technology (CHT), can refer patients for a telehealth consultation with UC Davis Health specialists by completing the referral process. Our telehealth consultations are a collaborative meeting between the primary care provider, specialist and patient.
Steps for Submitting a Telehealth Referral
Get Specialty Referral Guidelines — Contact our team at 916-734-4735 or via email to request detailed referral guidelines for each adult or pediatric specialty.
- Complete a Telehealth Referral Request Form (PDF) — Fax the form to 866-622-5944 or submit via email along with any documentation outlined in the referral guidelines. For specialties not listed, please provide as much documentation as possible to assist us in securing a one-time consultation.
- Confirmation Call — A UC Davis Health telehealth coordinator calls or emails you to schedule and confirm the consultation with the referring site's telehealth coordinator.
- Consultation Instructions — We provide instructions on how to connect for your consultation. We ask that all sites test the connection before the appointment date to ensure good audio/visual quality and review the use of any external telehealth peripherals that might be needed during the consultation.
- Additional Documentation — At least 10 business days before the consultation, submit the completed Telehealth Referral Request Form with the following documentation via fax or email:
Copy of patient’s insurance card(s) and insurance authorization (if applicable)
Completed Medicare Secondary Payer Questionnaire (MSPQ) form (if applicable)
Provide patient with UC Davis Health’s Notice of Privacy Practices in English or UC Davis Health’s Notice of Privacy Practices in Spanish and obtain signed and dated Acknowledgment of Receipt of UC Davis Health’s Notice of Privacy Practices in English (PDF) or Acknowledgment of Receipt of UC Davis Health’s Notice of Privacy Practices in Spanish (PDF)
All pertinent medical records, labs and tests as indicated in the referral guidelines - Confirm the Appointment — Notify your patient at least two business days prior to the consultation date and document the patient's verbal consent to participate in a telehealth consultation in the patient’s chart or electronic medical record. This reminds patients of their appointment and decreases no-shows.
- Complete Paperwork — Provide your patient with a copy of our Notice of Privacy Practices and fax a signed copy of our Acknowledgement of Receipt form to 866-622-5944 before the consultation. Document your patient's verbal consent to participate in a telehealth consultation in your patient's chart/electronic record.
Checklist for New Clinic Sites with the Sites Contracted for Telehealth (Provider-to-Provider) Program
Before submitting your first Sites Contracted for Telehealth (Provider-to-Provider) program referral, make sure your clinic has completed the new-site setup checklist, reviewed the applicable specialty referral guidelines and confirmed that the appropriate presenter will be available for the requested consultation.
Be sure to complete these steps:
- Review remote site guidelines — Explore essential guidelines and helpful tips to help ensure every telehealth visit is successful
- Complete a connection test — Contact the clinical telehealth coordinator at 916-734-4735 or telehealth@health.ucdavis.edu to schedule a connection test
- Participate in a meet-and-greet — Complete this with relevant UC Davis Health specialty representatives
- Register for PhysicianConnect — This is a secure online portal for accessing patient medical records
Tips for a Successful Telehealth Visit with the Sites Contracted for Telehealth (Provider-to-Provider) Program
Follow these best practices to help ensure a smooth, professional and patient-centered telehealth experience:
- Wait for the specialist before rooming the patient — Do not bring the patient into the room until the specialist confirms they are ready to begin the consultation
- Introduce the patient promptly — Introduce the patient to the specialist as soon as they enter the room.
- Keep technical issues out of the patient conversation — Do not discuss equipment problems in front of the patient. If technical personnel need to enter the room, ask the patient for permission first. If an equipment issue cannot be resolved promptly, move the patient to the waiting area until the consultation can resume.
- Keep staff and operational issues private — Do not discuss staff concerns or operational problems in front of the patient.
- Protect patient confidentiality — Keep doors closed whenever discussing patient information with patients or staff.
- Address technical problems immediately — Contact your designated technical support person or team as soon as a technical issue occurs.
- Identify everyone in the room — Make sure both the specialist and patient know who is present in the room at all times.
- Speak clearly and at a normal volume — During the consultation, speak clearly using a normal speaking voice. Remember that microphones can pick up even quiet conversations.
- Clean equipment between patients — Clean and disinfect medical scoping equipment according to applicable protocols between patients.
Since its inception, our Sites Contracted for Telehealth (Provider-to-Provider) program has provided real-time consultations across nearly 50 medical specialties and has supported more than 200 clinics and hospitals, many of them in rural and medically underserved areas.
Current specialty offerings include:
Adult Specialties
|
Pediatric Specialties
|
Contact Us
Our Sites Contracted for Telehealth (Provider-to-Provider) program can be reached at:
4610 X Street, Suite 2301
Sacramento, CA 95817
877-430-5332
Fax: 866-622-5944
telehealth@health.ucdavis.edu
Please note that our email address is not monitored 24/7 and is not intended to provide medical advice. Patients are advised to contact their primary care provider if they have any questions about their health. If it's an emergency, please call 911 or go to the nearest hospital.