Nemours/Alfred I. duPont Hospital for Children | PATIENT APPOINTMENT FORM

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Nemours/Alfred I. duPont Hospital for Children
PATIENT APPOINTMENT FORM
1600 Rockland Road Wilmington, DE 19803 | Hours: Monday-Friday 7:30 a.m. – 7:00 p.m.
Appointment availability varies by specialist.
Patient: __________________________________________________________________________________________________
Reason for Referral: (diagnosis code/comment)_______________________________________________________________________
Referring Physician:________________________________ Physician’s Phone Number:_______________________________________
Date
An appointment has been scheduled for your child at the Nemours/Alfred I. duPont Hospital for Children on ____________________________
at ______________ in _______________________ with _________________________________________________________
Time
Dept/Program
Name, if applicable
Call 1-800-416-4441 or visit Nemours.org/duponthospital and select
‘Make An Appointment’and your call will be returned within 48 hours.
____ Adolescent Medicine
____ Dialysis Unit
____ Muscles Disorders Program
____ Psychiatry
____ Allergy
____ Eating Disorder
____ Musculoskeletal Tumor Program
____ Psychology (Call 302-651-4560)
____ Apnea
____ Emergency Services
____ Neonatology
____ Pulmonary Function Lab
____ Attention Deficit &
Hyperactivity Disorder
____ Endocrinology/Diabetes
____ Nephrology
____ Pulmonary Medicine
____ Enuresis Program
____ Neurofibromatosis Program
____ Rehabilitation
____ Feeding & Dysphagia
____ Neurology/Epilepsy Program
____ Rehabilitation Engineering
____ Gait Lab
____ Neurosurgery
____ Gastroenterology
____ Nutrition Services
____ General Pediatrics
____ Ophthalmology
____ Genetics
____ Orthopedics
____ Growth Discrepancy Program
____ Osteogenesis Imperfecta
____ Headache Program
____ Otolaryngology (ENT)
____ Hematology/Oncology
____ Outpatient Surgery
____ Infectious Disease/Lyme
____ Pathology
____Lab Work*
____ Physical/Occupational Therapy
____ Lymphedema
____ Plastic Surgery
____ Medical Imaging
____ Prosthetics
____ 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
(seating & mobility)
____ Respiratory Care
____ Rheumatology
____ Speech Pathology
____ Spinal Dysfunction Program
____ Sports Medicine
____ Surgery
____ Urology
____ Weight Management
____ ________________________
____ ________________________
____ ________________________
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.
Appointment Scheduling:
Admissions:
Emergency:
Main Hospital Number:
302-651-4200 or 800-416-4441
302-651-4199
302-651-4186
302-651-4000
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Write down any questions you have about your child’s diagnosis. Items printed below may help you think of what you
want to discuss during your visit with our Nemours team.
My current concerns are:
What is the next step in treating my child?
New medications for my child:
What else can I do at home to help my child?
My child has experienced these new symptoms:
Are there any activities or foods my child should avoid?
Are there other symptoms that I should be looking for?
Ask the name of the diagnosis/condition.
Learn more at Nemours’ www.kidshealth.org. Information on our award-winning
site is reviewed by our Nemours physicians specifically for parents, teens and kids.
Please write down any additional questions you have for our Nemours team during your child’s visit.
_______________________________________________________________________________________________________________________________________
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DIRECTIONS TO THE HOSPITAL
1600 Rockland Road | Wilmington, DE 19803
From Rt 202 North:
Take Route 202 South. Look for the AstraZeneca campus on the right. Make a right at the
light onto Powder Mill Road (Route 141). Driving under a walkway overpass, stay on this
road 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 Route
202, 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 Drive
and 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 duPont
Experimental station, staying on Route 141 North (Powder Mill Road). Travel a mile and a half, making a
right at the second light onto Children’s Drive. The hospital is straight ahead through the gates.
To Rockland Center I, II, and Ronald McDonald House
Follow the directions above. On Children’s Drive, facing the hospital’s stone gates, turn left onto Rockland
Road. 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 building
past Rockland II.
Your child. Our promise.
Trouble finding us? Call 800-416-4441
Free parking and valet service are available around both the outpatient entrance
(near playground) and visitor’s lobby (around the back of the hospital).
©2010. The Nemours Foundation. Nemours is a registered trademark of the Nemours Foundation.
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