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  Prematurity Prevention Program
Department of Obstetrics & Gynecology
University of Washington School of Medicine
(206) 598-6959        (206) 598-4694 fax
Referral Information
Indications for referral:
  • Multiple gestation 
  • Previous preterm birth
  • Previous preterm labor
  • History of 2nd trimester loss(es)
  • Uterine anomalies
  • Previous cervical surgery
  • Incompetent cervix
  • Preterm labor in a current pregnancy
  • DES exposure
By telephone:
  • Call (206) 598-6959.  Please leave name, number and the best time to call back.  A Prematurity Prevention Program nurse will return your call.
  • Call the main Maternal and Infant Care Clinic number, (206) 598-4070 and ask the receptionist to page the Prematurity Prevention Program nurse.
By fax:

Patient information may also be faxed directly to (206) 598-4694 using the MS Word (.doc) or (Adobe Acrobat (.pdf) version of the fax referral form. You may download and save this form to your office computer, then print it, fill it in and fax it to us.

Information required from your office (To initally evaluate the patient, our nurse will need the following information):

  • Patient name, phone number(s), address
  • EDC, by LMP and/or by early US
  • Risk factor(s) for delivering preterm
  • Other medical problems
  • Prenatal flow sheets and chart notes
  • All US reports
  • Laboratory results, including serum screen, maternal blood type, Pap smear and any cultures
  • Insurance information, including referral, if needed
Feedback:
  • Referring providers will receive a consultation letter from one of our perinatologists after the patient is evaluated.
  • Providers may also access the information about their patients via the UWMC secure web site service known as U-Link.This is an exciting and efficient method of obtaining feedback on all of your referrals.  All physicians are encouraged to apply for U-Link privileges.
  • Providers are always welcome to contact the Prematurity Prevention Program directly during regular clinic hours.
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Last Updated:
3/31/03

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