Remote Second Opinion Service

• Credit Card Agreement Form
• Informed Consent Form
• Letter of Agreement

For the Letter of Agreement, please replace the highlighted field with the patient information and have an authorized representative (either the patient or an individual or family member on behalf of the patient) sign and date the form, and submit along with the credit card form, informed consent form and the patient's medical files for review.

• Diagnostic Radiology – All radiological images and corresponding reports are needed for the consultation and should be included with the SOMRR packet.
• Diagnostic Pathology – If the patient would like to have his or her specimen reviewed by a UC San Diego expert pathologist, the SOMRR Program offers this service for an additional fee, dependent on the type of slide (stained or unstained).

Due to United States Customs regulations, please write the following on the pathology slide/block commercial invoice: "Slides and/or paraffin blocks (and corresponding pathology reports) of non-infectious and non-contagious human tissue taken from the ____________ (name of organ or tissue) which are fixed and/or preserved in paraffin. This specimen has never been cultured. It is for review by the Department of Pathology at the University of California, San Diego. The value is US$1.00." This will help to avoid processing delays at Customs.

Attn: Medical Manager, re:SOMRR
UC San Diego Health
International Patient Program
136 Dickinson Street, Suite 108
San Diego, CA 92103-8222
Fax: 619-543-5282

Or, email to: patientsintl@ucsd.edu

It is imperative that all documents included are accurate and current, as the second opinion consultation is based on this information. Once the packet is approved by the SOMRR office, the second opinion process will begin.

• When UC San Diego Health receives the patient materials, we will first do a thorough check of all documentation to make sure it is complete, as the process cannot begin if information is insufficient or missing.
• Referring physicians will receive regular updates on the progress of the second opinion consultation, generally during our regular office hours, via your preferred form of communication (email, fax, teleconference, etc.). Once we begin the review, further charges will be applied if additional medical records are sent and/or questions are submitted.
• After a UC San Diego Health physician or surgeon completes the second opinion medical consultation, the patient's case will either be closed or, if requested, it will be transferred for follow-up treatment. If requested by the referring physician or the patient, an in-person consultation can be scheduled with a UC San Diego Health physician. Please contact UC San Diego Health International Services to inquire about this option.
• Please note: documents and records submitted for the second opinion medical consultation will not be returned, unless requested by the patient. After six months of inactivity, medical records will be appropriately discarded.