Physicians

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Physician Referral Form

Thank you for referring your patients to UMMC! We’re streamlining our electronic referral process with the following changes effective June 1, 2026.

We are retiring the secure online referral form available below.
We are transitioning to Epic for all electronic referrals.
- If your organization uses Epic, you can use the Epic Open Care Everywhere Referrals Management (Open CERM) process for seamless referral coordination.
- If your organization does not use Epic, you can use a free uView account. If you do not have a uView account, click here to get started, and use the Request New Account link. Please allow three business days to set up an account.

For questions or support, email uView@umc.edu. A team member will respond within one business day.

* - Required Fields

Patient Information
First Name*
Middle Name
Last Name*
Date of Birth*
Phone Number*
Alternate Phone
Address*
Address2
City, State Zip*	City State Zip -
Social Security #
Last 4 of Social Security #
Diagnosis / reason for referral*
Name of UMMC Physician or specialty area you would like to contact you:*	ALERT! This specialty requires a different process. Please use the alternate link provided here to request an appointment with the Children's Safe Center: https://cscreferral.umc.edu/
Does the patient have Molina Marketplace?	Yes No ALERT! UMMC is not in network with Molina Markplace. Please refer to an in-network Provider.
Referring Physician Information
DO, MD, NP or PA*	DO MD NP PA
First Name*
Last Name*
Clinic Name*
Address
Address2
City, State, Zip	City State Zip -
Email
Daytime Phone
Alternate Phone
Fax Number
Contact name for us to call back
Medical Records
Note	Attach or fax all related medical records to the following fax number: Adults (18 or older) 601-815-0327 Peds (under 18) 601-496-9617
Additional Comments