Acquired Autonomic Dysfunction Program Second Opinion New Patient Intake
To help our specialty team understand your child’s history and make sure a second opinion visit will be helpful, please submit the following information by email to AADPrecords@chop.edu or by fax at 215-701-0880:
- Download and fill out the AADP Second Opinion New Patient Intake Form. After completing the intake form, remember to save a copy to your computer before sending it to us.
- A parent or caregiver summary, describing in your own words what has led to your child’s symptoms. This helps us understand what you’re seeing day-to-day and ensures we have your perspective, not just the medical record.
You may submit the completed intake form and parent summary while still gathering medical records.
- A medical or clinical summary from the referring primary care provider or specialist. If the referring provider is at CHOP, you do not need to provide this summary.
- Send relevant medical records from outside institutions*, including:
- All specialty evaluations
- Primary care visits related to your child’s symptoms
- Emergency room and urgent care reports
- Medical test results
- Laboratory reports
- Growth chart
- Electrocardiogram (EKG) reports and strips
- Radiology images and reports related to your child’s symptoms (X‑rays, echocardiograms, MRIs, CT scans)
*If your child has been seen at facilities that participate in Care Everywhere, you can give permission through their patient portals to share those records directly with CHOP.
For all other records, please complete our AADP HIPAA form for each specialty or healthcare facility where your child has been treated, and send the completed forms to AADPrecords@chop.edu. You may also provide these forms to outside institutions so they can release records to CHOP.
- If your child is new to CHOP, please send a copy of the front and back of your insurance card.
Once we receive your child’s intake form and all required medical records, the AADP team will review the information to determine the most appropriate next steps. This review helps us understand your child’s treatment history and confirm whether a second‑opinion visit in AADP will be meaningful and beneficial.
Please allow 7 to 10 business days for our team to complete this review. After the review is finished, our program coordinator will contact you with the decision and guidance on the next steps.
AADP is a high‑demand program, and we work carefully to ensure that each patient we see can benefit from what our team offers. We appreciate your patience as we complete this process as thoroughly and thoughtfully as possible.