Addiction Medicine

Phone Number: 907-458-2634

Fax: 907-459-2527

Location: 1650 Cowles Street, Entry G, Fairbanks, AK 99701

(Note: The FHP Addiction Medicine Clinic has moved from 2111 East Cowles Street and is now co-located with the FHP 1st Care Clinic in the Hattan Building on the FMH Campus.)

Hours: 7:30 AM – 4:30 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/addiction_medicine

Referral Guidelines: Referrals are accepted by fax.

• Referrals are faxed to the Behavioral Health Clinic and reviewed for appropriateness to ensure the preferred provider offers the requested service.

• The clinic does accept self-referrals.

STAT/Urgent Referrals:

• Urgent referrals are not accepted; patients are directed to the FHP Emergency Department.

Referral Requirements:

• Include chart notes from the previous visit, along with the current medication list.

Required forms to be completed by the referring provider:

• No specific forms are required; however, chart notes and a clear justification for the referral are mandatory.

Provider Information:

• Peter Dillon, MD, FAAFP  •  Mindy Treybal, DO

Pre-authorization Process:

• Not required unless the referral is through Tricare or VA, in which case authorization must be obtained before scheduling.

Additional Information:

• Please provide detailed and comprehensive information tailored to support the needs of the referring provider.

Phone Number: 907-458-2635 Fax: 907-459-3541

Location: 

TVC Main Building, 1001 Noble Street, 3rd Floor, Suite 310,

Fairbanks, AK 99701

Hours: 8:00 AM – 5:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/allergy

Referral Guidelines: Referrals are accepted by fax.

• Following receipt of the referral, reception contacts the patient to coordinate scheduling.

STAT/Urgent Referrals:

• Referral is reviewed by the provider upon receipt, and the patient is promptly contacted to schedule an appointment.

Referral Requirements:

N/A

Required forms to be completed by the referring provider:

All necessary forms are provided in the office at the time of service and include:

• New Patient Form

• Eczema: POEM (Patient-Oriented Eczema Measure)

• Asthma: ACT/cACT (Asthma Control Test)

• Urticaria: UCT (Urticaria Control Test) and UAS7 (Urticaria Activity Score)

Provider Information:

• Anthony Bonitatibus, MD • James LaFleur, PA-C

Clinical Specialties and Expertise:

Allergy Testing, Asthma, Eczema, Urticaria, Allergy immunotherapy injections

• Treatments Offered: Biologic injections

Pre-authorization Process:

• For Tricare/TriWest patients: Please obtain and submit prior authorization from the appropriate agency for the requested services. Ensure the following CPT codes are included: 99202–99205, 99211–99215, and 99242–99245.

• For I.H.S./Chief Andrew Isaac Health Center (CAIHC) patients: A purchase order is required for the services requested.

Phone Number: 907-458-2644 Fax Number: 907-459-3521

Location: 2111 E. Cowles Street, Fairbanks, AK 99701

Hours: 7:30 AM – 4:30 PM, Monday – Friday

Webpage: https://www.foundationhealth.org/services/clinics_centers/specialty_care/behavioral_health

Referral Guidelines: Referrals are accepted by fax.

Routine Referrals:

• Routine referrals are faxed to the Behavioral Health Clinic and reviewed to ensure the preferred provider offers the requested service.

STAT/Urgent Referrals:

Not accepted.

Referral Requirements:

• Chart notes from previous visit to include medication lists.

Required forms to be completed by the referring provider:

• No forms required; chart notes and referral justification are mandatory.

Provider Information:

Psychiatry:

• Daniel Rohlf, MD

• Vanessa Miller, PMHNP

• Linda Summers, PMHNP

Psychological Testing: (No Autism Testing)

• Daniel Curns, PhD

Counseling:

• Jaime Ringstad, EdD, LPC

• Elizabeth Ricca, LCSW

• Robert Barnard, LPC

Pre-Authorization Process:

• Not required unless the referral is through Tricare or VA, in which case, authorization must be obtained before scheduling.

Phone Number: 907-458-5244 Fax Number: 907-458-6488

Location: 1650 Cowles Street, 1st Floor, Outpatient Center – North Tower, Fairbanks, AK 99701

Hours: 8:00 AM – 4:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/phvc/cardiac_rehab

Referral Guidelines: Referrals are accepted by fax.

• The outpatient Cardiac Rehabilitation program supports individuals with cardiovascular conditions in reducing their risk of future health issues through lifestyle improvement. The program offers a medically supervised, individualized conditioning plan tailored to each patient’s needs and limitations. A physician's order is required for participation.

• Cardiac Rehabilitation is beneficial for patients who have experienced a heart attack, angina, angioplasty, bypass surgery, valve surgery or intervention, or heart failure.

STAT/Urgent Referrals: N/A.

Referral Requirements: N/A.

Required forms to be completed by the referring provider:

• Outpatient Cardiac Rehabilitation Physician Order/Referral — include office notes.

Provider Information:

• Registered Nurses and Exercise Physiologists deliver cardiac rehabilitation programs under the clinical supervision of Cardiologists.

Pre-authorization Process:

• To qualify for Medicare coverage for Congestive Heart Failure (CHF), patients must meet specific criteria: at least 6 weeks post-event or hospitalization, clinically stable, and classified as NYHA Class II–IV despite optimal heart failure therapy, with an ejection fraction (EF) of ≤35%.

• Referral Signature Requirements: For Medicare and VA patients, a physician (MD) must sign cardiac rehabilitation (CR) referrals. Other private insurers allow referrals to be signed by physician assistants (PAs) or nurse practitioners (NPs).

• Pre-Authorization Requirements: Currently, VA, Tricare, and Moda are the only insurers that require pre-authorization for cardiac rehabilitation services.

• The VA Request for Services Form (RFS) for VA patients, can be completed by our team and submitted directly to the Department of Veterans Affairs for approval. For Tricare, the RFS form must be completed and submitted by Bassett for authorization.

Phone Number: 907-458-6450, option one for scheduling Fax Number: 907-458-6430

Location: 1650 Cowles Street, 1st Floor, Outpatient Center – North Tower, Fairbanks, AK 99701

Hours: 8:00 AM – 5:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/phvc/cardiology_clinic

Referral Guidelines: Referrals are accepted by fax. All cardiology patients seen in the office must be 18 years of age or older. Exception for Echos - patients age 17 and younger can be referred.

• Referral must include the patient’s name, date of birth, phone number, diagnosis, consult/evaluation request, and the ordering provider’s signature.

• Please also include the most recent H&P, relevant lab results, and any records related to the referral.

STAT/Urgent Referrals:

• Referrals must include the patient’s name, date of birth, phone number, diagnosis, consult/evaluation request, ordering provider’s signature, and must be clearly marked as STAT or Urgent.

• A provider reviews all STAT referrals to assess urgency, as appointment availability may be limited. The most recent H&P, relevant labs, and any related records should accompany the referral.

Referral Requirements:

• Patients must be 18 years or older for all diagnostic testing, except for pediatric echocardiograms.

Diagnostic Testing:

• Orders must include the patient’s name, date of birth, phone number, diagnosis, type of test requested, ordering provider’s signature, and the indicated level of urgency (e.g., routine, STAT).

• Scheduling timelines vary by insurance type, depending on the time required to obtain authorization.

Provider Information:

• Romel Wrenn, MD, Interventional Cardiologist

• David Jinich, MD, Interventional Cardiologist

• April Dunlevy, NP

• Kari Gondeck, NP

• Courtney Lee, PA

• Christina Sparks, NP

• Emily Wolf, PA

Pre-authorization Process:

• VA: RFS must be submitted.

• VA & Tricare: Patients will be scheduled at least 7 days out to allow time for authorization processing.

• IHS/CAIHC: Patients appointments are scheduled a minimum of 3 days out to accommodate authorization processing.

• All Other Insurance: Office visits are scheduled based on the next available appointment.

• Diagnostic Testing: Scheduling timelines vary by insurance type, depending on the time required to obtain authorization.

Additional information:

• Call the FHP Cardiology office to discuss cardiac diagnostic studies and catheterization lab procedures.

Phone Number: 907-458-2676 Fax Number: 907-458-2679

Location: 1919 Lathrop Street, Suite 207, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/endocrinology_diabetes

Referral Guidelines: Referrals are accepted by fax.

• Referrals are reviewed upon receipt to ensure appropriate provider placement.

• Nursing staff evaluate referrals to determine if any laboratory tests or other diagnostic procedures are required before the visit.

• Patients are contacted to schedule their appointment and are provided with instructions for completing lab tests 2–3 weeks in advance.

STAT/Urgent Referrals:

None.

Referral Requirements:

• Patient demographics

• Pertinent imaging

• Applicable chart notes

• Relevant lab results, preferably from the past year

• Reason for referral or visit

Required forms to be completed by the referring provider:

None.

Provider Information:

• Muhammad Ahmed, MD

Dr. Muhammad Ahmed specializes in the diagnosis and management of a wide range of endocrine and metabolic conditions, including Type 1 and Type 2 Diabetes, Acromegaly, Adrenal incidentaloma or mass, Adrenal insufficiency (with or without steroid therapy), Celiac disease, Chronic fatigue, Cushing’s syndrome, Diabetes insipidus (DI), Hypercalcemia, Hyperparathyroidism and Hyperprolactinemia and galactorrhea.

• Michael Parente, PA-C, provides Diabetes Management.

Location: 1650 Cowles Street, Fairbanks, AK 99701

Hours: 8:00 AM to 4:00 PM, Monday - Friday

Esophagogastroduodenoscopy (EGD), colonoscopy, and bronchoscopy are performed by a variety of Foundation Health Partners physicians, including internists, general surgeons, and family practice providers.

Scheduling depends upon the skill set and privileges of each endoscopist:

a) EGDs are performed by all endoscopists.

b) Colonoscopy is performed by all endoscopists.

c) Bronchoscopy must be scheduled with surgeons (Conley, Flowers, or Tsigonis).

d) Patients less than 18-years-old must also be scheduled with surgeons.

STAT/Urgent Referrals:

• If a patient requires urgent or emergent care (within the next 24 hours), please direct them to the FMH Emergency Department. Their care will be coordinated by the FMH Hospitalists on an inpatient basis.

The following offices schedule elective endoscopy procedures:

FMH Hospitalist Group - Phone: 907-458-5178 Fax: 907-458-5180

• Bruce Footit, MD

• Owen Hanley, DO

• Wendell Eames, MD

FMH General Surgery Group – Phone: 907-458-2652 Fax: 907-459-3542

• Dante Conley, MD, FACS

• Kristin Flowers, MD, FACS

• Abe Tsigonis, MD, FACS

FMH Internal Medicine Group – Phone: 907-459-3570 Fax: 907-459-3510

• Herbert Day, MD

• Michael Swenson, MD

Referral Guidelines: Referrals are accepted by fax.

• Elective referrals are accepted by fax at the numbers above.

• If the referring provider or patient has a preference regarding which physician performs a procedure, please send the referral directly to that physician’s office.

• If there is no preference, send the referral to the FMH Hospitalists.

• If a procedure is a follow-up (e.g. to assess healing after treatment for ulcer disease, removal of a large polyp, or because of an inadequate colon prep). Please refer them to the endoscopist who performed the original procedure.

Referral Requirements:

To ensure timely processing, all referrals must include:

• A signed physician’s order.

• Study requested (EGD, colonoscopy, bronchoscopy)

• Diagnosis

• Patient demographics

• Insurance information

• History & Physical (H&P)

• Current medication list

Required forms to be completed by the referring provider:

None.

Pre-authorization Process:

• The scheduling office (Hospitalists, General Surgery, or Internal Medicine) will submit information to the pre-authorization team for all procedures. This process may require up to two weeks.

Additional Information:

• Scheduling is based on the urgency conveyed in your referral. It is essential that the diagnosis associated with the endoscopy request is clearly marked.

• Additional factors impacting scheduling include physician availability, referring provider or patient preference, and prior authorization status.

• All cancer patient referrals are marked as high priority for expeditious scheduling.

• The endoscopy physician’s scheduling team will contact the patient directly to schedule the procedure and verify insurance coverage.

• The scheduling team will notify the referring provider if a patient declines to schedule.

• Pre-procedure instructions can be given in person, over the phone, by email, or mailed.

• When the procedure is scheduled, appointment details will be faxed to the referring provider.

• When the procedure has been completed, a report will be faxed to the referring provider by the FMH Procedures Department.

• Pathology results will be sent separately from the Pathology Department.

Phone Number: 907-458-2652 Fax Number: 907-459-3542

Location: 1650 Cowles Street, 4th Floor, South Tower, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday-Friday

We are a part of your community and truly appreciate the opportunity to care for people locally. We perform core procedures including hernia repair, appendectomy, cholecystectomy, colectomy, breast lumpectomy, mastectomy, lymph node biopsy, and hemorrhoidectomy. In addition, we provide long-term vascular access (Powerports); care for skin and soft tissue concerns (burn care, skin grafts, scar revision, wound debridement); perform thoracic surgery (bronchoscopy, VATS decortication and wedge); care for pediatric patients (hernia repair, pyloromyotomy, endoscopy/colonoscopy); perform endocrine surgery (thyroid, parathyroid); and provide diagnostic and therapeutic endoscopy services (esophagogastroduodenoscopy and colonoscopy).

Provider Information:

• Dante Conley, MD, FACS

• Abe Tsigonis, MD, FACS

• Kristin Flowers, MD, FACS

• Dayna Daku, PA-C

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/general_surgery

STAT/Urgent Referrals:

• If a patient requires emergent care (within the next 24 hours), please direct them to the FMH Emergency Department. Their care will be coordinated by the surgeon on call.

• Documents pertaining to urgent referrals (within the next week) are accepted by fax, but we recommend that these cases be discussed with one of our surgeons to ensure timely management.

• If you are unsure how to direct a referral, please call to discuss the case with one of our surgeons. You may use our cell phones or the FMH Operator at 907-452-8181.

• All cancer referrals are considered high priority to ensure a prompt response.

Referral Requirements:

• Reason for referral.

• Last H & P to include medication list.

• Patient demographic and insurance information.

• Relevant lab, imaging or test results (needed only if performed outside of Foundation Health Partners.)

Pre-authorization Process:

•Prior authorization (PA) is required for all VA patients before being seen in clinic. This authorization typically includes authorization for surgery.

•For patients with all other insurances, the authorization process starts after a decision for surgery has been made. The FHP pre-authorization team will obtain coverage for surgery as necessary.

Home Health - Phone Number: 907-458-5410 Fax Number: 907-458-5412

Location: 1701 Gillam Way, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday-Friday

Webpage:

https://www.foundationhealth.org/services/assisted_longterm_care/home_health_services

Referral Guidelines: Referrals are accepted by fax.

• Outside providers must complete the “routine referral” packet.

STAT/Urgent Referrals:

• STAT referrals are not accepted but are expedited when possible.

Referral Requirements:

• Patients must be over the age of 18; have insurance, be homebound, have a provider who is PECOS enrolled willing to sign HHC orders; have a skilled need for RN or PT, patient to have met with the referring provider face to face to discuss the HHC referral.

• Provider documentation from the 1:1 visit must include the HHC needs as discussed with the patient; any known home safety issues must be disclosed in the referral.

Required forms to be completed by the referring provider:

• Routine referral packet form.

Provider Information:

• Kendrick Blais, DO

• Nurses provide services.

Pre-authorization Process:

• Completed by Home Health staff at the time of referral.

Additional Information:

• Please provide as much detail as possible, ensuring the information is comprehensive and tailored to the needs of referring providers.

Hospice Care – Phone Number: 907-458-3090 Fax Number: 907-458-3066

Location: 2001 Gillam Way, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday-Friday

Webpage:

https://www.foundationhealth.org/services/assisted_longterm_care/hospice

Referral Guidelines: Referrals are accepted by fax.

None.

STAT/Urgent Referrals:

• Send by fax, and with follow-up with phone call.

Referral Requirements:

• Patients must have a terminal illness.

Required forms to be completed by the referring provider:

• Hospice Referral Form, Home Care Infection Control Referral Form, Demographics, Chart Notes, medication list and labs.

Provider Information:

• Kendrick Blais, DO

• Nurses provide services.

Pre-authorization Process:

None.

Additional Information:

• Patients can self-refer.

• Patients may choose one primary hospice physician, in addition to the hospice medical director.

Fax all orders to: 907-458-5598

Location: 1650 Cowles Street, at 19th & E. Cowles St., Fairbanks, AK 99701

Hours: 6:30 AM – 5:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/fibc

Referral Guidelines: Referrals are accepted by fax.

Types of orders:

• STAT (24 Hours)

• ASAP (48-72 Hours)

• Routine (Next Available)

Required forms to be completed by the referring provider:

• All outpatient services require a provider order or referral.

Referral Requirements:

N/A.

Provider Information:

• Radiology Consultants, Inc., https://www.alaskaradiologists.com/

Pre-authorization Process:

• Prior authorizations are done unless otherwise indicated.

Additional Information:

Services Offered:

• CT and 3T MRI

• Screening Mammography

• Diagnostic Mammography

• Walk-In Diagnostic X-Ray

• Nuclear Medicine (including Stress Testing)

• Ultrasound

• Bone Density Testing

• Lung Cancer Screening

• Cardiac CT Calcium Scoring (Cash Pay / Walk-In)

Additional Information:

•Questions? Please reach out by email to: AKRadManagers@foundationhealth.org

Phone Number: 907-458-5683, option two

Fax Number: 907-458-5123 and 907-458-5692

Location: 1650 Cowles Street, Fairbanks, AK 99701

Hours: 8:00 AM – 4:00 PM, Monday – Friday; weekends by appointment.

Referral Guidelines: Referrals are accepted by fax.

• Orders are sent to the Infusion Therapy via fax.

• No specific criteria for referrals; however, the referring provider must have FMH privileges.

STAT/Urgent Referrals:

• Same as routine; sometimes paper orders are hand-delivered. Fax is preferred.

Required forms to be completed by the referring provider:

• A written order is required for all infusions, injections, and related services, including PICC insertions, PICC dressing changes, and stimulation tests. Services are provided for adult, senior, and pediatric patients.

• Offices may use their own physician order forms or request a blank copy of our order form. All medication orders require a Hypersensitivity/Anaphylaxis protocol form with clear indications for treatment.

Provider Information:

• Nurses provide services.

Pre-Authorization Process:

• Once orders are received, they are scanned into a RightFax folder. OR Schedulers then contact patients and add them to the schedule.

• Scheduling generates a report used by the Pre-Auth Team to initiate the pre-authorization process; occasionally, OR Schedulers may reach out via Teams to start the process earlier.

• Pre-authorization timelines vary; some cases may take 2 weeks to 1 month to complete.

Additional information:

• The pharmacy is often consulted when an order includes a less commonly used medication.

• The Pharmacy buyer determines availability and estimated delivery time.

• In some cases, pre-authorization must be completed before scheduling or ordering the medication due to high cost and non-returnable status.

Phone Number: 907-458-5640

Location: 1650 Cowles Street, 2nd Floor, Fairbanks, AK 99701

Hours: See Collection Locations below.

Webpage:

https://www.foundationhealth.org/services/laboratory

Lab Specimen Testing - Collection Locations and Hours

Fairbanks Imaging & Breast Center (FIBC) soon to be the Hattan Building

907-458-6960

1650 Cowles St., Fairbanks, AK

Monday–Friday: 6:30 AM – 5:30 PM

Saturday: 8:00 AM – 4:00 PM (Closed Holidays)

JMCCC (Cancer Center)

907-458-5380

1650 Cowles St., Fairbanks, AK

Monday–Friday: 7:30 AM – 4:00 PM (Closed Holidays)

Doolittle Medical Building

907-458-3327

1919 Lathrop St., Fairbanks, AK - TEMPORARILY CLOSED; will reopen in November 2025.

Tanana Valley Clinic

1001 Noble St., 1st Floor, Fairbanks, AK – PERMANENTLY CLOSED.

Additional Information:

Services Available:

• Over 200 tests available on-site with results typically delivered within 24 hours of sample collection — most bloodwork is completed within 4 hours.

• Courier Services: Available on a scheduled basis or upon request.

• Digital faxing of results: Fast, secure delivery of test outcomes.

• Mayo Clinic Laboratories Partnership: through this collaboration, 99.9% of all testing needs are fulfilled.

• On-Site Pathologists: Accessible for physician consultations.

Phone Number: 907-458-5176 Fax Number: 907-458-2819

Location: 1650 Cowles Street, 4th Floor, South Tower, Fairbanks, AK, 99701

Webpage:

https://www.foundationhealth.org/our_community/fhp_healthbreak/new_parent_clinic

Referral Guidelines: Referrals are accepted by fax.

• The provider fills out the Adult Lactation order for breastfeeding parent.

• The provider sends the order to Central Scheduling.

Required forms to be completed by the referring provider:

• Provider fills out Adult Lactation Order for breastfeeding parent.

• Include the diagnosis code and sign the order.

• Provider sends order to FHP Central Scheduling.

Forms:

· #1622- New Parent Clinic Adult (for lactation and feeding needs)

· #1623- New Parent Clinic Pediatric (for repeat hearing screens or occasional

bilirubin test)

Provider Information:

Please print your name, include the diagnosis code, and sign the order.

Pre-authorization process:

No pre-authorization is required.

Additional information:

The New Parent Clinic is an RN-run lactation clinic. A provider order is required for all

lactation consults and hearing screen follow-ups.

Phone Number: 907-459-3540 Fax Number: 907-459-3542

Location: 1650 Cowles Street, 4th Floor, South Tower, Fairbanks, AK, 99701

Hours: 8:00 AM – 4:30 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/obgyn

Referral Guidelines: Referrals are accepted by fax.

• External referrals are faxed to us in RightFax, and internal referrals are sent to the OBGYN Reception Group via NextGen.

STAT/Urgent Referrals:

• Referrals should be labeled STAT to enable reception staff to route them to clinical staff as “high priority.”

Referral Requirements:

None.

Required forms to be completed by the referring provider:

• In office procedures (the Peri-OP department manages the surgery forms.)

• The provider gives instructions on completing and submitting each form.

Provider Information:

• Mariah Minder, MD, OBGYN

• Allyson Jones, MD, OBGYN

Pre-authorization process:

• Prior Authorization (PA) is required for all VA patients before being seen in the clinic.

• Pregnant Patients: No prior authorization is required for OB-related appointments or procedures.

• Non-Pregnant or GYN Patients: The referring provider must initiate the PA process with the VA before the referral is submitted.

• Surgical Procedure PAs are managed separately by the FMH Precertification Department.

Additional information:

Scheduling Guidelines for High-Risk and Twin Pregnancies

• All twin and high-risk pregnancies must be scheduled with an MD. Referrals sent to PA or CNM will be redirected to the appropriate physician provider.

Phone Number: 907-459-3545 Fax Number: 907-328-0474

Location: 1919 Lathrop Suite, Suite 105, Fairbanks, AK, 99701

Hours: 8:00 AM – 4:30 PM, Monday - Saturday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/orthopedics

Referral Guidelines: Referrals are accepted by fax.

Routine Referrals:

• When a referral is received, our team will reach out to the patient to schedule an appointment. If the patient does not answer, a second call will be made within two business days.

• After two unsuccessful call attempts, it becomes the patient’s responsibility to contact us to schedule their appointment.

• For New Patients: After the appointment is scheduled, please advise the patient to request that their chart notes be faxed to our office.

STAT/Urgent Referrals:

STAT/Urgent referrals are accepted, indicate the urgency on the referral.

Referral Requirements:

• For New Patients: After the appointment is scheduled, please advise the patient to request their chart notes be faxed to our office.

Required forms to be completed by the referring provider:

None.

Provider Information:

• Stewart Kerr, MD – Spine Care and a broad spectrum of orthopedics

• Gary Molk, DO – Trauma, Hip and Knee Replacements

• David Huntsman, DPM – Podiatry

• Nathan Marsh, MD – Sports Medicine

• Shannon Dieffenderfer, PA-C

• Jennifer Holt, PA-C

• Kelsey Thompson, PA-C

Pre-authorization process:

• Requirements for pre-authorization: Imaging done in the last three months, chart notes, and any OP notes.

• Pre-authorization is required for Tricare and VA referrals.

Additional Information:

• Self-referrals are accepted, except for Tricare/VA.

Phone Number: 907-458-2619 Fax Number: 907-374-1089

Location: 1919 Lathrop Suite, Suite 105, Fairbanks, AK, 99701

Hours: 8:00 AM – 4:30 PM, Monday - Saturday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/omm

Referral Guidelines: Referrals are accepted by fax.

Routine Referrals:

• When a referral is received, our team will reach out to the patient to schedule an appointment. If the patient does not answer, a second call will be made within two business days.

• After two unsuccessful call attempts, it becomes the patient’s responsibility to contact us to schedule their appointment.

• For New Patients: After the appointment is scheduled, please advise the patient to request that their chart notes be faxed to our office.

STAT/Urgent Referrals:

STAT/Urgent referrals are accepted, indicate the urgency on the referral.

Referral Requirements:

None.

Required forms to be completed by the referring provider:

None.

Provider Information:

• Bethany Chernich, DO

• Jennifer Ribar, DO

• Mary Joy, DO

• Stefan Leo-Nyquist, DO

• Stefanie Lai, DO

• Todd Capistrant, DO

• Tristan Glenn, DO

Pre-authorization Process:

• Pre-authorization is required for Tricare and VA referrals.

Additional information:

• Self-referrals are accepted, except for Tricare/VA.

Phone Number: 907-374-4546 Fax: (907)458-5241

Location: 1650 Cowles Street, 1st Floor, South Tower, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday – Friday

Webpage:

https://www.foundationhealth.org/services/hospital_care/pediatrics

Referral Guidelines for STAT/Urgent Inpatient Consults – Pediatric and Neonatal ICU

• For all STAT or urgent consults, please contact the in-house on-call pediatrician.

NICU (907) 458-5224 Pediatrics (907) 458-5325

• Fax all relevant medical records to the unit the patient will be transferred to:

Pediatrics: (907) 458-5328 NICU: (907) 458-5228

Outpatient Prenatal Consults:

Pediatric hospitalists are available for outpatient prenatal consults when there are identified medical concerns involving the mother or baby that may affect care during or immediately after delivery. These consultations are intended for patient with specific medical concerns and are not meant for routine prenatal visits.

Required forms to be completed by the referring provider:

• No forms are needed for STAT consults.

• For Routine Referrals, call the Pediatric Hospitalist Office at (907) 374-4546 to request the form.

Provider Information:

• Laura Brunner, MD – Medical Director

• Tiffany Borbon, MD

• Carla Cartagena DeJesus, MD

• Brynn Ehlers, DO

• Anne Hanley, DO

• Mishelle Nace, MD

• Jeri Rosenbloom, MSN, APRN, PNP-PC

Pre-authorization process:

• Pre-authorization is not required for emergent transfers to the NICU or Pediatric unit. Pre-authorization may be required for outpatient prenatal consults.

Additional Information:

None.

Phone Number: 907-458-5676 Fax: 907-458-5598

Location: 1650 Cowles Street, 3rd Floor, South Tower, Fairbanks, AK 99701

Hours: 8:00 AM – 4:00 PM, Monday - Thursday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/respiratory_care/pft

Referral Guidelines: Referrals are accepted by fax.

• All patient referrals are called within five business days.

STAT/Urgent Referrals:

• Indicate STAT/Urgent Referral on the order form and fax to FMH Central Scheduling

Referral Requirements:

• Call te PFT office if you have questions on the referral requirements.

Required forms to be completed by the referring provider:

• All PFT services require a signed written order.

Provider Information:

• Services are provided by registered respiratory therapists.

Pre-authorization Process:

• Pre-authorization for outpatient PFT services may be required and is insurance dependent.

• Patient appointments are scheduled once prior authorization is obtained, typically one to two weeks out.

Additional Information:

Comprehensive respiratory evaluation services are available, including:

• Arterial Blood Gases (ABGs)

• Bronchial Hygiene Device and Instruction

• Bronchial Provocation Testing

• Complete Pulmonary Function Testing

• Induced Sputum Collection

• Overnight Oximetry

• Pentamidine Therapy

• Six-Minute Walk Tests

• Spirometry (Pre and Post)

Phone Number: 907-458-5380 Fax Number: 907-458-5379

Location: J. Michael Carroll Cancer Center (Cancer Center), 1650 Cowles Street, Suite 2, Fairbanks, AK 99701

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/jmccc

Referral Guidelines: Referrals are accepted by fax.

There are several types of referrals accepted:

• Radiology Oncology Routine Referrals

• Social Work Routine Referrals

• Cancer Navigation Provider Routine Referral

• Dietitian Routine Referrals

STAT/Urgent Referrals:

• Referrals are never labeled “stat;” the provider reviews each referral, and they determine urgency.

Referral Requirements:

None.

Required forms to be completed by the referring provider:

• Provider Referral form.

Provider Information:

• Essam Shihadeh, MD, Radiation Oncologist, North Star Radiation Oncology

• Brittany Stepovich, ANP-C, AOCNP

• Kari Velzke, MSW, Ph.D., LCSW

• Alyssa Prolock, RDN, LD

Pre-authorization Process:

• Prior authorization reviews are completed for all patients.

Additional information:

• Patients may self-refer but should first confirm with their insurance company that the service is covered.

Phone Number: 907-458-5670 Fax: 907-458-3071

Location: 19 College Road, Suite D, Fairbanks, AK 99701

Hours: 7:30 AM – 6:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/rehabilitation

Referral Guidelines: Referrals are accepted by fax.

Routine referrals are FAXED to 907-458-3071

Referrals must include the patient’s name, date of birth, phone number, diagnosis, type (PT/OT/SLP), ordering providers signature and date.

Please instruct patients to call the Rehab office to schedule

STAT/Urgent Referrals:

• Indicate “STAT/Urgent Referral” along with the reason for urgency on the fax cover sheet and order form.

• STAT/Urgent referrals are prioritized and scheduled at the earliest available appointment time.

• For post-surgical patients, please indicate date of surgery, timeframe to start therapy, and any precautions or contraindications.

Referral Requirements:

Type: Physical Therapy and/or Occupational Therapy or Speech Language Pathology

Required forms to be completed by the referring provider:

• All referral forms are accepted.

Provider Information:

• Licensed therapists and assistants provide services.

Pre-authorization Process:

VA: RFS must be submitted by the referring provider

VA & Tricare: Patients will be scheduled at least 7 days out to allow time for authorization processing

IHS/CAIHC: Patients appointments are scheduled for a minimum of 3 days out to accommodate authorization processing.

All Other Insurance: Visits are scheduled based on the next available appointment.

• The Rehab Department verifies patient insurance and contact information, and prior authorization is obtained, if necessary, before initial evaluation.

Additional Information:

• Comprehensive therapy offerings include Occupational, Physical, and Speech-Language Pathology.

• Individual insurances have varied limits on the maximum number of annual visits for OT, PT, and SLP services. These visits are tracked by the insurance authorizations as needed.

• Certified Hand Therapists (OT): hand, elbow, and wrist specialists

• Certified Lymphedema Therapist (OT & PT): specialize in upper and lower extremity edema, breast cancer recovery and measurement for custom compression garments.

SLP Video Fluoroscopic Swallow Studies (VFSS)

*Outpatient procedure with Radiology

Location: North Tower Entrance A, 1650 Cowles Street, Fairbanks, AK 99701

Hours: 08:00 AM - 4:00 PM, Monday-Friday by appointment

Webpage:

www.foundationhealth.org/services/clinics_centers/specialty_care/rehabilitation

Referral Guidelines:

• Routine referrals should be faxed to CENTRAL SCHEDULING at 907-458-5598

• Procedure on referral should read: SLP Video Fluoroscopic Swallow Study/VFSS

• Referral must include the patient’s name, date of birth, phone number, diagnosis, procedure type, date of referral and the ordering provider’s signature.

• For pediatric VFSS referrals, it is encouraged to trial outpatient SLP interventions prior to VFSS.

STAT/URGENT Referrals:

*On the fax cover sheet, indicate “STAT/URGENT” and then state the reason for the urgency.

*These referrals are prioritized and scheduled at the earliest available appointment time/date.

Referral Requirements:

OP adult and pediatric SLP Video Fluoroscopic Swallow Studies

Required Forms:

*All referral forms are accepted.

Provider Information:

*Licensed certified SLP’s provide services in conjunction with the Radiology team

*MBSImp certification

Pre-Authorization Process:

• Completed by Central Scheduling

Phone Number: 907-458-5676 – Respiratory Therapy

Phone Number: 907-458-5336 – Therapy Manager Fax: 907-458-5598 Central Scheduling

Location: 1701 Gillam Way, Suite A, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday - Thursday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/respiratory_care

Referral Guidelines: Referrals are accepted by fax.

• Routine and STAT referrals are sent to Central Scheduling fax.

STAT/Urgent Referrals:

• Indicate “STAT/Urgent Referral” along with the reason for urgency on the fax cover sheet and order form.

• STAT/Urgent referrals are prioritized and scheduled at the earliest available appointment time.

Referral Requirements:

None.

Required forms to be completed by the referring provider:

• All PFT services require a signed written order.

Provider Information:

• Respiratory therapists provide services.

Pre-authorization Process:

• Pre-authorization for outpatient PFT services may be required and is insurance dependent. Appointments are typically scheduled for one to two weeks out.

Additional Information:

• Adult and Pediatric EEGs are provided in partnership with an external Pediatric Neurologist.

• Long-term and short-term studies are available, including continuous monitoring.

• Routine and STAT outpatient studies.

• On-call EEG services are available for acute needs through the FHP Emergency Department or Inpatient care.

• Outpatient EKG appointments are scheduled through FMH Central Scheduling.

Phone Number: 907-458-5421 Fax: 907-458-5026

Location: 1701 Gillam Way, Suite B, Fairbanks, AK 99701

Hours: 9:00 AM – 5:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/sleep_dme

Referral Guidelines: Referrals are accepted by fax.

• Fill out the Positive Airway Pressure (PAP) devices order form: https://www.foundationhealth.org/services/clinics_centers/specialty_care/sleep_dme/sleepdme_docs/pap_order

• Routine Referrals are processed within five business days.

STAT/Urgent Referrals:

• Please indicate “STAT/Urgent Referral” and the reason for urgency on the order form or on the fax cover letter.

Required Forms:

• Complete the PAP Order form and fax it to the office.

• Patients with Alaska Medicaid will require a Certificate of Medical Necessity Form.

Provider Information:

• New PAP set-ups are scheduled and completed by Sleep DME staff.

Pre-authorization Process:

• All referrals are checked for insurance verification and pre-authorization requirements.

Additional Information:

•BiPAP & CPAP therapy: appointments required for mask fittings and PAP setups.

• Supplemental Oxygen.

• On-site walk-in support and supply pick-up.

Phone Number: 907-458-2630 Fax Number: 907-459-3508

Location: 1650 Cowles Street, 4th Floor, South Tower, Fairbanks, AK 99701

Hours: 8:00 AM – 4:30 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/urology

Referral Guidelines: Referrals are accepted by fax.

• Referrals can be faxed over; our staff will review them and reach out to the patient to schedule an appointment.

STAT/Urgent Referrals – Required Information:

• Referrals can be faxed over, staff and/or providers will review the referral and reach out to the patient to schedule the next available/fit in on schedule when openings come up.

Required forms to be completed by the referring provider:

• Procedures/surgeries, IPSS consults, ED/SH consults. Instructions to complete and the forms are given to the patient on the date of service.

Provider Information:

• Shannon Smith, MD, MPH •Jen Lucey, PA-C

Pre-authorization Process:

• The patient’s insurance coverage, procedure name, proposed date of service are submitted to the prior authorization team.

• The information is reviewed and processed by the PA team, with turnaround typically completed within a few business days.

Additional information:

Specialties and areas of expertise:

• Overactive bladder, urinary incontinence, kidney stones, benign prostatic hyperplasia (BPH), cancers of the genitourinary tract, including bladder, testicular, and penile cancers, Peyronie’s disease, erectile dysfunction, and urethral stricture disease.

• Self-referrals are accepted.

Phone Number: 907-458-6450 Fax Number: 907-6430

Location: 1650 Cowles Street, First Floor, Fairbanks, AK 99701

Hours: 8:00 AM – 5:00 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/vascular_center

Referral Guidelines: Referrals are accepted by fax.

• Referrals must include the patient’s full name, date of birth, phone number, diagnosis, reason for consultation/evaluation, and the ordering provider’s signature.

• Please include the most recent History & Physical (H&P), relevant lab results, and any supporting medical records related to the referral.

STAT/Urgent Referrals:

• STAT/Urgent referral must include the patient’s full name, date of birth, phone number, diagnosis, request for consultation or evaluation, ordering provider’s signature, and indicate if the referral is STAT or Urgent.

• STAT office visits are accepted.

Referral Requirements:

• Include the most recent H & P and any relevant medical records.

• Diagnostic testing orders must include the patient’s full name, phone number, diagnosis, specific test requested, ordering provider’s signature, and noted urgency (e.g., routine, STAT, etc.).

Required forms to be completed by the referring provider:

None.

Provider Information:

• Mark Ombrellaro, MD

• Lydia Knuths, PA-C

• Toula Farnsworth, PA-C

Pre-authorization Process:

• VA: RFS submitted. VA & Tricare patients will be scheduled at a minimum of 7 days out to give time to process authorization.

• I.H.S./Chief Andrew Isaas Health Center (CAIHC) patients will be scheduled at a minimum of 3 days out, giving time to obtain and process authorization.

• All other insurance will be scheduled for the next available for office visits.

• For Diagnostic testing, the timeline varies based on insurance type for minimum days out to process authorizations.

Additional Information:

Specialties and areas of expertise:

• Aneurysms (Abdominal and Thoracic Aortic Aneurysms)

• Buerger’s Disease

• Carotid Artery Disease

• Deep Vein Thrombosis (DVT)

• Evaluation and management of a broad range of vascular conditions, including:

• May-Thurner Syndrome

• Peripheral Artery Disease (PAD)

• Peripheral Venous Disease

• Raynaud’s Disease

• Renal Artery Disease

• Varicose Veins

Treatment Options:

• Atherectomy

• Angioplasty

• Embolization

• Endarterectomy

• Endovenous Laser Treatment (EVLT)

• Radiofrequency Ablation

• Sclerotherapy

• Stenting

• Thrombolysis

• Vascular Bypass Surgery

Numerous diagnostic test options are also available:

• (AAA) Abdominal Aortic Ultrasound

• ABI Segmented Pressures: With or without exercise

• Arterial Duplex

• AV Fistula Evaluation

• Carotid Duplex

• Endovenous Laser Treatment (EVLT)

• Renal Artery Complete

• Renal Artery Limited

• Vascular diagnostic studies, patients age 10+

• Vein Mapping

• Venous Insufficiency (Reflex)

• Venus Duplex

Phone Number: 907-458-3346 Fax Number: 907-458-5011

Location: 1650 Cowles Street, 3rd Floor, Fairbanks, AK 99701

Hours: 7:00 AM – 3:30 PM, Monday - Friday

Webpage:

https://www.foundationhealth.org/services/clinics_centers/specialty_care/wound_and_ostomy_care

Referral Guidelines: Referrals are accepted by fax.

• Use Form 1645FH to include History & Physical (H&P) and other relevant notes. Authorization must be obtained from the referral office, not the wound clinic (except for VA patients).

STAT/Urgent Referrals:

• Stat referrals are not available. Emergent or urgent cases should be directed to FHP 1st Care Center or the FHP Emergency Department (ED).

Referral Requirements:

•Our clinic specializes in advanced wound care. As such, we do not accept referrals solely for routine foot care diagnoses such as dystrophic nails or onychomycosis, even in diabetic patients. Due to increasing community demand for wound care and limited staffing, general foot care services were discontinued several years ago.

• Foot care may still be provided when a patient is referred for an active, draining diabetic or neuropathic foot ulcer or another lower extremity wound. In these cases, foot care may be addressed as time allows, provided it supports the primary wound-related referral.

• Incisional dressing changes are not performed unless there is wound dehiscence.

• Ostomy care is provided, including assistance with coordinating supply deliveries.

• Timely referrals: Early referrals are encouraged, as the clinic typically has a minimum wait time of two weeks. To ensure timely post-operative care, schedule referrals in advance when surgery requiring advanced wound management is planned.

Required forms to be completed by the referring provider:

• Refer to the instructions above. Be sure to include the History & Physical (H&P) and any relevant clinical notes.

Provider Information:

• Cristiane Kaufmann, MD

• Debra Booysen, FNP-C

• Dennis Rogers, PA-C

Pre-authorization Process:

• Routine preauthorization is the responsibility of the referring provider’s office, except for VA referrals. If additional authorization is required for skin substitute treatments, negative pressure wound therapy (vac), the clinic will manage the process, as these therapies often necessitate six or more weeks of care.

Specialties and Areas of Expertise:

• Arterial and venous ulcers

• Diabetic foot ulcers

• Frostbite injuries

• Lymphedema treatment is not available at this clinic and is managed by Outpatient Rehab - Occupational Therapy (OT).

• Please note: Routine dressing changes and standard post-operative care are not provided. The focus is on developing and managing comprehensive wound care plans, with adjustments as healing progresses.

• Post-operative care usually falls under the surgeon’s bundled payment and should be managed by the surgical team.

• Post-surgical wounds requiring negative pressure wound therapy (wound vacs)

Additional Information:

• Missed Appointments for Routine Care: Patients who miss three routine appointments without prior notice will be discharged from the clinic and must be re-referred to resume care.

• No-Show Policy for New Consultations: Patients who fail to attend their initial consultation without prior notice will be placed at the end of the scheduling list. Referring providers are notified of no-shows.

• Osteomyelitis Management: Patients diagnosed with osteomyelitis will be referred to their primary care provider for continued management, as it falls outside the clinic’s scope.

• Provider Communication: Referring providers receive updates throughout the patient’s care course.

• Treatment Planning: Treatment plans are developed by the clinic’s wound care providers upon consultation. If the referring provider predetermines a specific treatment plan, referral to the wound clinic may not be appropriate.