For physicians

Thank you for choosing Wesley for your patient's imaging exams. We have streamlined our ordering process and invite you to print order forms to assist in providing accurate patient information.

Please select the proper PDF form, print it, and complete it. Fax the form, along with the patient's current medication list, recent lab values (if done within 30 days), pertinent medical reports and other helpful information. If you choose to hand-write the information, please use a bold black pen.

Please note the patient name at the top of each sheet.

Fax completed forms to (833) 965-0104.

We look forward to working with you to enhance the patient experience and ensure the best possible outcomes.

• Diagnostic Imaging
• Lung Cancer Screening Assessment and Order Form
• Nuclear Medicine Imaging
• Outpatient Breast Imaging
• Outpatient CT Imaging
• Outpatient MRI Imaging
• Ultrasound Imaging
• Vascular/Interventional Imaging

These forms require Adobe Reader. If you do not have Adobe Reader, you may download it free here.

Physician’s offices may fax orders to Wesley at (316) 962-7827. All faxed orders may take up to two hours to process. Bringing a written order with you to the Bronchiolitis Clinic may provide faster service.

Wesley Medical Center Emergency Department
550 N. Hillside
Northeast corner of Central and Hillside streets
(316) 360-0010

Wesley Derby ER
2648 N. Rock Road, Derby
Southeast corner of E. Patriot Avenue and Rock Road
(316) 360-0012

Wesley West ER
8714 W. 13th St. N
Northeast corner of 13th Street and Tyler Road
(316) 360-0011

Wesley Woodlawn Hospital & ER
2610 N. Woodlawn
On Woodlawn, between 21st and 29th streets
Phone: (316) 358-3025
Open 6 a.m. to 10 p.m. every day
Clinic wait times depend on hospital emergencies and the number of patients waiting for the clinic.
Do not feed your child while waiting for a respiratory therapist.
Children cannot be suctioned for at least 30 minutes after they stop eating due to increased risk of vomiting or aspiration.

Bronchiolitis can be a very frustrating illness for you and your baby. Increased nasal mucus can make it hard for your baby to breathe. Babies often feel tired and cranky but can’t sleep well. They may also have a hard time eating and drinking.

We have created an Outpatient Bronchiolitis Clinic so that your baby’s airway may be cleared of mucus using the hospital’s powerful suction equipment.

Bronchiolitis is an infection of the lower airways that is almost always caused by a virus. The infection irritates the lower airways and causes excess mucus production and swelling of the airways.

Initial symptoms are similar to that of the common cold, and can include a stuffy or runny nose, mild cough and low fever. After a couple of days the cough can get worse and babies may develop a wheeze. Wheezing is a whistling like sound, when they breathe. Breathing can become difficult for children as the mucus production increases, and becomes thick.

Very young babies can have difficulty clearing this mucus on their own. Some children require hospitalization due to difficulty breathing.

Symptoms generally begin to clear after 7 to 10 days. The cough can last for several weeks, while the airways heal. Sleeping and eating routines may take several days to return to normal.

Viruses that cause bronchiolitis are spread easily through droplets in the air when someone who is sick coughs, sneezes, or talks. These viruses can also be spread by touching contaminated surfaces or objects.

Careful handwashing is the best protection against infection. Babies who are in daycare and babies exposed to cigarette smoke may be more likely to get the infection.

Make sure your baby gets plenty of fluids. Give the fluids in smaller amounts on a more frequent feeding schedule.

Using a cool mist humidifier to moisten the air will help loosen the mucus. Clean the humidifier daily to help prevent mold growth. Use nasal saline drops and a nasal aspirator suction device to help clear your baby’s nose of mucus. The baby will feed better if the nose is clear. After each use, be sure to clean the suction device carefully with soap and hot water to eliminate germs.

Call your doctor if your baby has any of the following:

• Seems sleepier than usual
• Is pale
• Has less than three wet diapers in 24 hours
• Is working hard to breath or breathing fast
• Has a high fever — 100.4° if your baby is less than 2 months old or 102.2° if your baby is more than 2 months old

When you visit one of our locations, please enter at the Emergency Department entrance. Tell the nurse at the reception desk that you are here for the bronchiolitis clinic. The nurse will briefly assess your baby, and then direct you to the admissions desk for the clinic. After the admissions clerk registers your child, a respiratory therapist will be notified that you are waiting.

Do not feed your child while waiting for the respiratory therapist. Children cannot be suctioned for at least 30 minutes after they stop eating due to increased risk of vomiting or aspiration.

The respiratory therapist will meet you and your baby in the waiting room, and escort you to an exam room. Your baby will be assessed by the respiratory therapist, and the baby’s nose will be cleared of mucus using suction and saline. Then your baby will be reassessed.

If the assessment indicates your baby is tolerating the symptoms well, the respiratory therapist will provide you with an education packet and return visit instructions. If the assessment indicates that your baby may not be handling this illness well, the respiratory therapist may call your doctor. For children that appear to be very ill, the respiratory therapist will ask an emergency doctor to evaluate your baby, and determine if the patient needs to be admitted.

If an emergency doctor evaluates your baby, you will be charged for an emergency room visit as well as for the visit to the clinic.