For Referring Providers
We are not currently accepting referrals related to MTHFR, Direct-To-Consumer test interpretation, or Factor V Leiden. If you have specific questions, please contact our team.
- Please enter an ambulatory referral to Adult and Cancer Genetics in Epic.
- Please include the reason for the evaluation in the “comments” section. Your patient will be contacted to schedule an appointment.
- If your patient has relevant medical records that are not in Epic, please fax a copy of these records to 919-966-4151.
- Please complete this form and fax it to 919-966-4151.
- Your patient will be contacted to schedule an appointment.
If your patient has been diagnosed or treated outside of the UNC system:
- Please provide us with relevant clinic notes and test reports.
- Please also provide us with a copy of any previous genetic test results.
For connective tissue disorders (such as Marfan syndrome)
- Rheumatology clinic notes
- Echocardiogram report
- Ophthalmology clinic notes
- Relevant medical records for relatives with the same condition or symptoms (for example, clinic notes documenting a diagnosis in a relative, genetic test report for a relative, etc.)
For hereditary neurological conditions and neuromuscular diseases (such as Huntington disease, ataxia, Alzheimer disease, Duchenne muscular dystrophy, or hereditary neuropathy)
- Neurology clinic notes
- Neuroimaging reports
- Electrophysiology study results (EMG, NCV)
- Relevant medical records for relatives with the same condition or symptoms (for example, neurology notes documenting a diagnosis in a relative; an autopsy report confirming Alzheimer disease in a relative; genetic test report for a relative; etc.)
For suspected mitochondrial disorders and/or metabolic disorders
- Relevant biochemical/metabolic test results (for example, acylcarnitine profile, organic acid levels, amino acid levels, etc.)
- Neurology clinic notes and results of related testing or imaging
- Clinic notes from previous genetic evaluations (including any test results)
- Relevant medical records for relatives with the same condition or symptoms (for example, clinic notes documenting a diagnosis in a relative, genetic test report for a relative, etc.)
For intellectual disability and/or autism syndromes (such as Fragile X syndrome)
- Neuropsychology notes
- Clinic notes from previous genetic evaluations (including any test results)
- Relevant medical records for relatives with the same condition or symptoms (for example, clinic notes documenting a diagnosis in a relative, genetic test report for a relative, etc.)
For conditions involving dysmorphic features or congenital anomalies (birth defects)
- Clinic notes and/or imaging reports documenting features
- Neuropsychology notes
- Clinic notes from previous genetic evaluations (including any test results)
- Relevant medical records for relatives with the same condition or symptoms (for example, clinic notes documenting a diagnosis in a relative, genetic test report for a relative, etc.)
For inherited cardiac conditions (such as long QT syndrome or cardiomyopathy)
- Cardiology clinic notes
- Relevant cardiology results (for example, ECG results, echocardiogram results, etc.)
- Relevant medical records for relatives with the same condition or symptoms (for example, clinic notes documenting a diagnosis in a relative, genetic test report for a relative, etc.)
If you have specific questions about which records may be relevant for your patient:
- please call LaTonya Williams at 919-843-8724 and ask to speak to the genetic counselor on call.