DAC Appt Request
Offices
Patient Info
DOB
Dialysis Unit
Davita Alameda
Davita Oakland
Davita Berkeley
Davita San Pablo
Davita El Cerrito
Davita Richmond
Davita Vallejo
Davita Benicia
Davita Carquinez
DSI Berkely
RAI Bancroft
RAI Piedmont
RAI East Bay
RAI Peralta
RAI Fairfield
Other
Referring Physician
Appointment within
ASAP
2 weeks
3 weeks
4 weeks
6 weeks
Reason For Referral
Clot Aspiration on HD
Known Recurrent Stenosis
Edema of Extremity
Excessive Bleeding
Vasc-Alert
High VDP
High Recirculation
Immature Fistula
Low Kt/V
Painful Cannulation
Pulsatile Access
Low Blood Flow
Clotted Access
Cuff Cath Insertion
Cuff Cath Removal
Cuff Cath Exchange
Cuff Cath Repair
