Andrew Barbash, MD

Request Neurology Consult

Pilot program of a direct neurology triage form for use directly by physicians or mid-level providers . This is not for use by unit clerks or support staff. It is intended for directly conveying to the neurology coverage team what you need and when.

Hospital/Facility (from list) *

PLEASE NOTE...in a live program there would be a separate form just for YOUR hospital so you would not need to enter this separately. That form would be automatcially delivered securely to an Updox Team Inbox. The Neurologists who are credentialed at your facility would all have access to that team inbox queue and whoever is working on shift or available to assist with extra needs would be notified on their mobile phones, access the queue and respond back to you.

Physician/Staff Name *

Your Mobile Phone *

I must be able to send you back an SMS text message. If you do not have a mobile phone able to accept a text message please do not use this form.

Patient Location *

Hospital Floor/ICU

Hospital ED

Rehab Center

Skilled Nursing Facility

Community Health Clinic

Other

Most likely diagnosis *

Acute Stroke-TPA High Probability

Acute Stroke-TPA Possible but uncertain

Acute Stroke-TPA not likely but Neuro Intervention very possible

Stroke-unsure of onset or details

Focal signs/symptoms of uncertain cause

Seizures

Altered Mental Status

Generalized Weakness

Other

For Acute Stroke Cases *

Please check all that apply, which will help the neurologist rapidly triage the case and make sure your needs are met<br/>

Clinical Details (optional)

What Timeframe Do You Need a Response? *

As soon as possible

Within 15 minutes

Within 30 minutes

Within 60 minutes

Within the next 4 hours

Any time later today

No urgency, no preference

What services do you need? *

Direct Video Consult with Patient

Phone/Text Advice Only

Imaging Tests Review

EMR Notes/Data Review

Other

Please make sure your staff calls the case into the Consult Coordination Center so that it can be logged and also assigned out accordingly. The SOC Consult Center Number is 855-216-1075.

Available Forms

TESTING-Hospital Neurology Request-NeuroDox Form

Request Neurology Consult