Referrals and Transfers

Referrals to Galveston’s Shriners Hospitals for Children

Shriners Hospitals are operated by the Shrine of North America. All medical care provided at Shriners Hospital is provided free of charge.
Children to the age of 18 years, who have received a burn injury and live in North America, may be eligible for treatment.

Phone: 409-770-6773 Referral Sheet

Application Form - English / Spanish

Acknowledgment Form - English / Spanish

Emergency Admissions

For emergency burn admissions, the referring physician should telephone a physician at the Shriners Hospital in Galveston and indicate the patient needs emergency care. Information will be requested concerning the patient’s demographic information, medical history and physical assessment including a description of the burn injury. A Referral Sheet and a Burn Diagram will be filled out.

Non-emergency Admissions

Non-emergency admission to the Galveston Hospital is dependent on the medical needs of the patient and on the availability of beds. Application forms for non-emergency admissions to a Shriners Hospital can be obtained from any Shrine Temple or Shrine Club; or by calling the Shriners Hospitals for Children toll-free referral line at 1-800-237-5055. (In Canada, call 1-800-361-7256.)

Foreign Patient Requirements

The child's parent/guardian will need to accompany the patient to the hospital. This is imperative for treatments/surgical consents as well as for emotional and psychological support for the patient during their stay. The parent/guardian will be trained in the care of the patient and will be responsible for care while the patient is an outpatient.
Although all medical treatment if provided free of charge, the hospital cannot be responsible for any transportation, food or lodging for the parent/guardian or for any expenses incurred while a child is an outpatient in the United States.
A medical history of the child must be provided (i.e. past/present diseases or conditions, previous surgeries, hospitalizations, etc.).
Round trip transportation between the home country and the United States, for the child and guardian must be guaranteed prior to acceptance. Confirmation of this would be copies of airline tickets or similar documents.
Please provide a letter from a local physician stating that medical treatment is available for this child upon return to his/her country.

Approximate costs while at Shriners Hospital

Costs for parent lodging and meals may range from approximately $140.00 to $245.00 per week depending on the place of lodging.