For Physicians

If you are a physician wishing to refer a patient to UCLA, please provide us with any or all of the following information:

• All general medical information
• All medication records
• Cardiac history and physical
• Recent physician notes (including all procedural notes)
• ECGs
• Holter/event recorder (please include tracings)
• Electrophysiology study reports
• Ablation or device reports
• Echocardiogram reports
• Stress testing reports
• Nuclear studies
• Cardiac MRI/ CT reports
• Any other records you feel will be necessary to evaluate patient
• Patient demographics and Insurance information
• All patient barriers (including language, cognitive, physical and cultural)