Andrew Barbash, MD - Publicforms

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TESTING-General Neurology Request

Curbside Advice for General Tele-Neurology

THIS IS FOR USE ONLY BY PHYSICIANS RESPONSIBLE FOR THE PATIENTS CARE. This is posted immediately into a secure team inbox. A Neurologist credentialed at your facility who is participating in this curbside advice service will contact you back.

Your Name (Healthcare Provider) *

Your Mobile Phone (for IM) *

A mobile number at which we can send an SMS Text Message Now

Hospital/Facility

Hospital/Facility *

This service is provided to hospitalists and other clinicians in one of the listed hospitals in which we have direct EMR access and also have efficient ways to communicate. If you enter a name not listed we will still message back to your mobile phone.

Clinical Details

Clinical Issue or History *

Clinical Action Needed

What Type of Help is Needed? *

Quick Question/Curbside Advice

Review Data or Imaging

Direct Patient Video Consult

Other

How Soon is Response Needed? *

15-30 Minutes

30-60 Minutes

Within 4 Hours

By End of Day

Optional Fields

Patient Name

Neurologist Requested (if known)

Your Email (first time users)

If this is your first time using this process please provide the email address you check most often. We will likely send an invitation to a Secure Messaging service for future needs and followup communications.

* Required field