St. Joseph Health System
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The Coumadin Clinic Protocol for physicians referring to our clinic are as follows:

a) When the physician wishes to make a referral to the Coumadin Clinic, a completed "Patient Referral Order" form is faxed to the Coumadin Clinic office. We request that a recent H&P or progress note including current medications list. If the patient is an established Coumadin patient, we request a copy of their INR results for the past 6 months. The Coumadin Clinic staff will contact the patient within 24 hours of receiving the referral unless the referral is received on weekends/holidays. In that case, the patient will be contacted during the Coumadin Clinic hours. (Monday - Thursday 0800 - 1630, Friday 0800 - 1200)

b) Once we receive the referral form, the physician is faxed a copy of the Coumadin Clinic Guidelines, Anticoagulation Dosing Protocol, and Patient Coumadin Clinic Agreement form.

c) After reading the above information, the physician signs a "Physician Acknowledgement of Coumadin Clinic Guidelines" form and an "Authorization for Renewal of Coumadin and Lovenox Prescription" form. The forms are then faxed to the Coumadin Clinic.

d) The patient will be called for initial appointment.

Please call with any questions.


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