Refer a Patient

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Type of Diagnostics (Stress Test, Holter Monitor, Cardiac Event Monitor, EKG)

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Discharge Date
• Insurance
• Hometown
• History and Physical
• Pulmonary or Cardiac
• Supporting Documentation
• Primary Physician
• Cardiologist
• Surgeon
• Referral Site Phone Number

Please fax the order to Cardiac Rehab at (605) 696-8828. Questions may be directed to Cardiac Rehab at (605) 696-8065.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Type of Scan
• With or Without Contrast
• Patient Weight
• Insurance Authorization
• Physician Signature
• Completed CT Screening Form
• If ordering a Lung Cancer Screening CT, completed CT Lung Screening Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Nuclear Medicine at (605) 696-8059.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Recent Lab Results
• Physician Signature and Printed Name
• Completed Diabetic Educator Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

A signed order is not needed for e-consult/telemedicine services. However, our scheduling team will need the following pieces of information in order to book the appointment:

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

No referral is required for foot care. If you would like us to contact the patient to setup an initial appointment, please send the following:

• Patient Name
• Date of Birth
• Patient Phone Number

Please fax the information to Central Scheduling at (605) 696-8889 or e-mail BHSCentralScheduling@brookingshealth.org. Patients may also directly setup their own appointment by calling Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Referring Provider Phone Number
• Service Request (Home Health, Hospice or HEARTH)

Please fax the order to Home Services at (605) 696-8832. Questions may be directed to Home Health & Hospice Director at (605) 696-8090.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Referring Provider Phone Number
• Service Requested (Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Bath Aide)

Please fax the order to Home Services at (605) 696-8832. Questions may be directed to Home Health & Hospice Director at (605) 696-8090.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Referring Provider Phone Number
• Service Requested (Home Health, Hospice or HEARTH)

Please fax the order to Home Services at (605) 696-8832. Questions may be directed to Home Health & Hospice Director at (605) 696-8090.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Dosage and Length of Treatment

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis ICD 10 Code
• Insurance Authorization
• Physician Signature
• Completed Lab Test Order Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient/Representative Phone Number
• Diagnosis
• Payer Source: Medicare, Medicaid or Private
• Physician Order
• List of Current Medications
• Recent History and Physical

Please fax the order to the Social Worker at (605) 696-8709 or call (605) 696-8714.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Type of Scan
• With or Without Contrast
• Patient Weight
• Completed MRI Screening Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Patient Weight
• Type of Scan

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Nuclear Medicine at (605) 696-8059.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature and Printed Name
• Recent Lab Results
• Completed Dietitian Order Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature

Please fax the order to Rehab/Therapy Services at (605) 696-8820. Questions may be directed to Rehab/Therapy Services at (605) 696-8060.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance
• Last Clinic Note Related to the Referral

Please fax the order to Yorkshire Eye Clinic & Optical at (605) 696-8824. Questions may be directed to Yorkshire Eye Clinic & Optical at (605) 696-8870.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature

Please fax the order to Wound Care at (605) 696-8814. Questions may be directed to Wound Care at (605) 696-8068.

Order Requirements

Patients may walk-in with a signed doctor order for lab work at any time. Walk-in patients should present their signed order to the Emergency Department receptionist.

Formal referrals require: 

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Lab Tests to be Performed

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Laboratory at (605) 696-8048.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Completed Pain Management Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Patient Weight
• Type of Scan
• Completed Order Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Nuclear Medicine at (605) 696-8059.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature

Please fax the order to Rehab/Therapy Services at (605) 696-8820. Questions may be directed to Rehab/Therapy Services at (605) 696-8060.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Test Type (PFT, Mask Fitting, Pulmonary Screening)
• Physician Signature

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient/Representative Phone Number
• Diagnosis
• Payer Source: Medicare, Medicaid or Private
• Physician Order
• List of Current Medications
• Recent History and Physical

Please fax the order to the Social Worker at (605) 696-8709 or call (605) 696-8714.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Supporting Documentation
• Completed Sleep Study Form

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature

Please fax the order to Rehab/Therapy Services at (605) 696-8820. Questions may be directed to Rehab/Therapy Services at (605) 696-8060.

Order Requirements

• Patient Name
• Contact Information for Person Making the Referral

Swing Bed patient referrals can be made by calling the Case Management department at (605) 696-8016. You may also fax a patient referral to (605) 696-8803.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Type of Scan

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Insurance Authorization
• Physician Signature
• Completed Wound Center Referral Form

Please fax the order to the Wound Center at (605) 696-8814. Questions may be directed to Wound Center at (605) 696-8068.

Order Requirements

• Patient Name
• Date of Birth
• Patient Phone Number
• Diagnosis
• Type of Scan
• Insurance Authorization
• Physician Signature

Please fax the order to Central Scheduling at (605) 696-8889 or send a scanned, signed order to BHSCentralScheduling@brookingshealth.org. Questions may be directed to Central Scheduling at (605) 696-8888.