Combination-case coordination

Request urology support for a case

For UTMCK surgeons who need University Urology in a planned combination case. Tell us about the patient, the case, and when you'd like it - we'll confirm a surgeon and date.

Records stay in PowerChart - nothing is uploaded here About 3 minutes Routed straight to UU scheduling

Patient

Who the case is for. Records should already be in PowerChart.

Patient name*

Patient name is required.

Date of birth*

Required.

Status*

Required.

Medical record number*

MRN is required.

FIN numberif known

OR roomif known

Requesting provider

Who we contact to coordinate.

Requesting surgeon*

Requesting surgeon is required.

Service / departmentoptional

Scheduler or contactoptional

Callback numberoptional

Secure email*

Secure email is required.

Case & intervention

What's planned and what you need from urology.

Case planned by requesting surgeon*

Describe the planned case.

UU surgeon requested*

Select a urologist.

Case urgency

Estimated urology time

Required intervention by urologic surgeon*

Tell us what's needed from urology.

Discussed with requested urologist?

Discussion noteoptional

Scheduling

Pick a target date - use the assistant on the right to see availability.

Expected date of surgery*

Tap a colored day in the scheduling assistant to fill this automatically.

Choose an expected date.

Selected availability

Not selected yet

Add date flexibility optional - helps us fit you in

Alternate acceptable dates

Acceptable range - start

Acceptable range - end

Case is already posted in the OR system optional

Posted room

Posted date

Posted time

Records confirmation

Required before submission.

Patient records are available in PowerChartDo not upload records or imaging here. Use PowerChart for source clinical records.

Relevant PowerChart locationoptional

Fill the required fields to submit