Clinical Telehealth Program - Pediatric Specialties
Behavior & Development*
Dermatology - Store and Forward
Neuromuscular Disease Medicine
Otolaryngology Cleft and Craniofacial
Psychology - Medical Health and Behavior
Psychology - Mental Health and Evaluations
*Offered by contract only. For contracted services or specialties not listed, please contact Candace Sadorra, UCD Health System Clinical Telehealth Program Manager, at (916) 734-4243 or email@example.com. To download a list of specialties, please click here.
Referring and Scheduling
Complete a Telehealth Referral Request Form and fax it to (866) 622-5944 along with any documentation outlined in the referral guidelines (see "Pediatric Specialties" section, above left, for specific guidelines). For specialties not listed, please provide as much documentation as possible to assist us in securing a one-time consultation, though this is not always possible depending on departmental staffing and resources.
A Telehealth coordinator will call you to schedule your appointment, and/or request additional information, if necessary. We will also provide you with the IP address to dial for your consultation. We ask that all sites test the connection prior to 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.
Please remember to confirm the appointment with your patient two business days prior to the date of the consultation.
On the day of the appointment, please 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 prior to beginning the consult. Document your patient's verbal consent to participating in a telehealth consultation in your patient's chart/electronic record.
- Do's and Don'ts for a Remote Site (PDF)
- ENT Questionnaire (PDF)
- Genomic Medicine Flyer (PDF)
- Genomic Medicine Questionnaire (PDF)
- Pediatric Behavior and Development Questionnaire (PDF)
- Notice of Privacy Practices (PDF)
- Notice of Privacy Practices [Spanish] (PDF)
- Notice of Privacy Practices: Acknowledgement of Receipt (PDF)
- Patient Satisfaction Survey (PDF)
- Provider Satisfaction Survey (PDF)
- Telehealth Referral Request Form (Microsoft Word)
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