Referral by Fax
Complete the appropriate referral form and fax it to 417-269-0692.
Referral by Phone
Call 800-637-9201 to speak directly with an intake coordinator.
Referral Forms
- Actemra
- Benlysta
- Cystic Fibrosis
- Dermatology Drugs A-E
- Dermatology Drugs F-R
- Dermatology Drugs S
- Dermatology Drugs T-Z
- Gastroenterology
- Hepatitis B
- Hepatitis C
- HIV
- Hypercholesterolemia
- Immune Globulin Intravenous
- Immune Globulin Subcutaneous
- Multiple Sclerosis Infusion Agents
- Multiple Sclerosis Ocrevus
- Multiple Sclerosis Oral Agents
- Multiple Sclerosis Self-Injectable Agents A-D
- Multiple Sclerosis Self-Injectable Agents E-Z
- Neuromuscular Disorder
- Obstetrics
- Oncology
- Osteoporosis
- Pulmonary
- Remicade
- Rheumatology A-E
- Rheumatology F-R
- Rheumatology S-Z
- Urology
- Women’s Health
Online Referral Through Allscripts
If you are an ECIN subscriber, then click here to login to Allscripts Care Management.
