Submit A Referral for Bone Marrow Transplant

Our BMT intake team (RNs and Intake Coordinators) can be reached via email bmtintake@seattlechildrens.org or by calling our clinic directly at 206-987-2106. Our BMT referral page (Refer a Patient - Pediatric Blood and Marrow Transplant Program (seattlechildrens.org) has the following information and resources on how to refer a pt to BMT.

• New Appointment Request Form (PDF) (DOC)
• Step-by-step guide to submitting a referral
• New Patient Referral FAQ
• If imaging studies (CT, MRI, X-rays) have been done, upload to PowerShare or mail a disc to:
• ATTN: BMT Intake
  Seattle Children's Cancer and Blood Disorders Center
  P.O. Box 5371/ MB.8.501
  Seattle, WA 98145-5005
  

Please include when referring a patient to BMT (this list of records needed may vary depending on patients’ initial diagnosis):

• Service/specialty clinic requested (Blood and Marrow Transplant Program)
• Reason for referral
• ICD-10 diagnosis – required.
• Visit type:
• New patient consult, transfer of care, second opinion or return visit/ongoing care.
• All relevant clinical documents:
• Clinic notes
• Medication history
• Growth charts/curves
• Lab reports
• Pathology reports
• Imaging and diagnostic reports (images can be uploaded to PowerShare)
• Previous specialty evaluations
• Previous operative reports, if available
• Patient’s full name, date of birth, sex, address, guardian contact information and insurance.
• Referring provider’s name, phone, fax and the referral coordinator’s email address so that we may contact you if additional information is needed.
• If an interpreter is needed
• Any known barriers to performing a successful telehealth (video) visit with the family.