Nemours/Alfred I. duPont Hospital for Children
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Patient: __________________________________________________________________________________________________ Reason for Referral: (diagnosis code/comment)_______________________________________________________________________ Referring Physician:________________________________ Physician’s Phone Number:_______________________________________ An appointment has been scheduled for your child at the Nemours/Alfred I. duPont Hospital for Children on ____________________________ at ______________ in _______________________ with _________________________________________________________ 1600 Rockland Road Wilmington, DE 19803 | Hours: Monday-Friday 7:30 a.m. – 7:00 p.m. Appointment availability varies by specialist. Nemours/Alfred I. duPont Hospital for Children PATIENT APPOINTMENT FORM ____ Adolescent Medicine ____ Allergy ____ Apnea ____ Attention Deficit & Hyperactivity Disorder ____ Audiology/Hearing Aids ____ Augmentative Communication ____ Behavior Consultation ____ Cardiology/Cardiothoracic Surgery ____ Cast Room ____ Cerebral Palsy ____ Children’s Advocacy Center ____ Cystic Fibrosis Program ____ Day Medicine ____ Dentistry (Call 302-651-5880) ____ Dermatology ____ Developmental Pediatrics ____ Diagnostic Clinic ____ Dialysis Unit ____ Eating Disorder ____ Emergency Services ____ Endocrinology/Diabetes ____ Enuresis Program ____ Feeding & Dysphagia ____ Gait Lab ____ Gastroenterology ____ General Pediatrics ____ Genetics ____ Growth Discrepancy Program ____ Headache Program ____ Hematology/Oncology ____ Infectious Disease/Lyme ____Lab Work* ____ Lymphedema ____ Medical Imaging ____ Muscles Disorders Program ____ Musculoskeletal Tumor Program ____ Neonatology ____ Nephrology ____ Neurofibromatosis Program ____ Neurology/Epilepsy Program ____ Neurosurgery ____ Nutrition Services ____ Ophthalmology ____ Orthopedics ____ Osteogenesis Imperfecta ____ Otolaryngology (ENT) ____ Outpatient Surgery ____ Pathology ____ Physical/Occupational Therapy ____ Plastic Surgery ____ Prosthetics ____ Psychiatry ____ Psychology (Call 302-651-4560) ____ Pulmonary Function Lab ____ Pulmonary Medicine ____ Rehabilitation ____ Rehabilitation Engineering (seating & mobility) ____ Respiratory Care ____ Rheumatology ____ Speech Pathology ____ Spinal Dysfunction Program ____ Sports Medicine ____ Surgery ____ Urology ____ Weight Management ____ ________________________ ____ ________________________ ____ ________________________ Call 1-800-416-4441 or visit Nemours.org/duponthospital and select ‘Make An Appointment’and your call will be returned within 48 hours. Date Time Dept/Program Name, if applicable Appointment Scheduling: 302-651-4200 or 800-416-4441 Admissions: 302-651-4199 Emergency: 302-651-4186 Main Hospital Number: 302-651-4000 Please arrive 15 minutes prior to your appointment to allow for registration. You are asked to bring any pertinent data such as medical records or X-ray films that may be helpful. Insurance information such as claim forms, insurance cards, co-pays, HMO referral forms, etc., must be presented at the time of registration. * NEW SCHEDULING PROCEDURE FOR OUTPATIENT LAB The Outpatient Specimen Collection Area (OSCA) at AIDHC schedules routine blood collections and other lab work. Families should call Central Scheduling at 800-416-4441, M - F, 8:00 a.m. to 7:00 p.m. to schedule their child’s lab visit. Patients with a STAT lab request from their physician do not require an appointment.
Transcript of Nemours/Alfred I. duPont Hospital for Children
Patient: __________________________________________________________________________________________________
Reason for Referral: (diagnosis code/comment)_______________________________________________________________________
Referring Physician:________________________________ Physician’s Phone Number:_______________________________________
An appointment has been scheduled for your child at the Nemours/Alfred I. duPont Hospital for Children on ____________________________
at ______________ in _______________________ with _________________________________________________________
1600 Rockland Road Wilmington, DE 19803 | Hours: Monday-Friday 7:30 a.m. – 7:00 p.m.Appointment availability varies by specialist.
Nemours/Alfred I. duPont Hospital for ChildrenPATIENT APPOINTMENT FORM
____ Adolescent Medicine
____ Allergy
____ Apnea
____ Attention Deficit &Hyperactivity Disorder
____ Audiology/Hearing Aids
____ Augmentative Communication
____ Behavior Consultation
____ Cardiology/Cardiothoracic Surgery
____ Cast Room
____ Cerebral Palsy
____ Children’s Advocacy Center
____ Cystic Fibrosis Program
____ Day Medicine
____ Dentistry (Call 302-651-5880)
____ Dermatology
____ Developmental Pediatrics
____ Diagnostic Clinic
____ Dialysis Unit
____ Eating Disorder
____ Emergency Services
____ Endocrinology/Diabetes
____ Enuresis Program
____ Feeding & Dysphagia
____ Gait Lab
____ Gastroenterology
____ General Pediatrics
____ Genetics
____ Growth Discrepancy Program
____ Headache Program
____ Hematology/Oncology
____ Infectious Disease/Lyme
____Lab Work*
____ Lymphedema
____ Medical Imaging
____ Muscles Disorders Program
____ Musculoskeletal Tumor Program
____ Neonatology
____ Nephrology
____ Neurofibromatosis Program
____ Neurology/Epilepsy Program
____ Neurosurgery
____ Nutrition Services
____ Ophthalmology
____ Orthopedics
____ Osteogenesis Imperfecta
____ Otolaryngology (ENT)
____ Outpatient Surgery
____ Pathology
____ Physical/Occupational Therapy
____ Plastic Surgery
____ Prosthetics
____ Psychiatry
____ Psychology (Call 302-651-4560)
____ Pulmonary Function Lab
____ Pulmonary Medicine
____ Rehabilitation
____ Rehabilitation Engineering(seating &mobility)
____ Respiratory Care
____ Rheumatology
____ Speech Pathology
____ Spinal Dysfunction Program
____ Sports Medicine
____ Surgery
____ Urology
____ Weight Management
____ ________________________
____ ________________________
____ ________________________
Call 1-800-416-4441or visit Nemours.org/duponthospital and select‘Make An Appointment’and your call will be returned within 48 hours.
Date
Time Dept/Program Name, if applicable
Appointment Scheduling: 302-651-4200 or 800-416-4441Admissions: 302-651-4199Emergency: 302-651-4186Main Hospital Number: 302-651-4000
Please arrive 15 minutes prior to your appointment to allow for registration. You are asked to bring any pertinent data such as medical records or X-ray films thatmay be helpful. Insurance information such as claim forms, insurance cards, co-pays, HMO referral forms, etc., must be presented at the time of registration.
* NEW SCHEDULING PROCEDURE FOR OUTPATIENT LAB The Outpatient Specimen Collection Area (OSCA) at AIDHC schedulesroutine blood collections and other lab work. Families should call Central Scheduling at 800-416-4441, M - F, 8:00 a.m. to 7:00 p.m. toschedule their child’s lab visit. Patients with a STAT lab request from their physician do not require an appointment.
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©2010. The Nemours Foundation. Nemours is a registered trademark of the Nemours Foundation.
Your child. Our promise.
Please write down any additional questions you have for our Nemours team during your child’s visit.
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Write down any questions you have about your child’s diagnosis. Items printed below may help you think of what youwant to discuss during your visit with our Nemours team.
My current concerns are:
New medications for my child:
My child has experienced these new symptoms:
Are there other symptoms that I should be looking for?
What is the next step in treating my child?
What else can I do at home to help my child?
Are there any activities or foods my child should avoid?
Ask the name of the diagnosis/condition.Learn more at Nemours’ www.kidshealth.org. Information on our award-winningsite is reviewed by our Nemours physicians specifically for parents, teens and kids.
From Rt 202 North:Take Route 202 South. Look for the AstraZeneca campus on the right. Make a right at thelight onto Powder Mill Road (Route 141). Driving under a walkway overpass, stay on thisroad and it will become Children’s Drive and take you through the hospital gates.
From North or South I-95:From I-95 North, take Exit 8 – Concord Pike/Route 202 N exit. Stay to the left. On Route202, get in the far left lane. Turn left at the 3rd light onto Powder Mill Road (Route 141).Driving under a walkway overpass, stay on this road and it will become Children’s Driveand take you through the hospital gates.
From the West:Take Route 141 North (Barley Mill Road), crossing the Tyler McConnell Bridge. Turn left at the duPontExperimental station, staying on Route 141 North (Powder Mill Road). Travel a mile and a half, making aright at the second light onto Children’s Drive. The hospital is straight ahead through the gates.
To Rockland Center I, II, and Ronald McDonald HouseFollow the directions above. On Children’s Drive, facing the hospital’s stone gates, turn left onto RocklandRoad. Rockland I is the first office building on your left. Rockland II is the second building on your left.A parking garage is located between I and II. The Ronald McDonald House is the large, yellow buildingpast Rockland II.
DIRECTIONS TO THE HOSPITAL1600 Rockland Road | Wilmington, DE 19803
Trouble finding us? Call 800-416-4441Free parking and valet service are available around both the outpatient entrance(near playground) and visitor’s lobby (around the back of the hospital).
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