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San Francisco Health Network

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Gender Health SF


Gender Affirming Surgery Access & Services

Gender Health SF GAS Flow


For Primary Care Providers: How to make a surgery referral or ask a consult question


Patient’s primary care provider submits an e-Consult in Epic (or via CareLink for SFCCC clinics). The Gender Health SF e-Consult can be found by typing “transgender” into the Orders function within a patient chart.

Using this e-Consult, you can do 3 things:

  1. Ask a clinical consultation question pertaining to gender affirming care, including hormone therapy.
  2. Make a complete surgery referral for patients with Full Scope Medi-cal, Medicare A&B, San Francisco Health Plan (including Healthy Workers and Healthy Families) with SF Health Network medical group, or Healthy San Francisco.
    1. Make a complete surgery referral for patients with Full Scope Medi-cal, Medicare A&B, San Francisco Health Plan (including Healthy Workers and Healthy Families) with SF Health Network medical group, or Healthy San Francisco.
  3. Refer any patient in our system of care who is seeking gender affirming surgery for Peer Navigation services. For patients who have Anthem BC Medi-Cal, the PCP simultaneously submits the surgery referral directly to the selected surgeon’s office; GHSF does not process the surgery referrals themselves.

Please see Insurance & Health Benefits Matrix for more information about surgical coverage & benefits referral process


Key points for successful surgery referral submission:

  • All referrals & supporting documents must be made through Epic or CareLink. Please do not fax or email surgery referrals or supporting documents as they will not be processed.
  • Necessary documents for a complete referral include: e-Consult and all questions answered, recent progress note and H&P, and pre-surgical assessment(s) that correlate with surgery(ies) referred for.
  • Prior to submitting an e-Consult for surgery, ensure that patient has completed the required Pre-Surgical Assessment(s) (PSA) with a licensed mental health provider(s) and document(s) are scanned into the patient chart under Media in Epic; only referrals with the necessary documents listed above in the chart will be accepted as complete. Incomplete referrals will be returned to PCP with instructions for completion.
  • We no longer require a separate Med Eval form or signed patient education forms; this content is now addressed within the e-Consult questions themselves.


Hair Reduction

The primary care provider's clinic completes all facial and body hair reduction requests for electrolysis or laser. As of this writing, these services are only available to patients with San Francisco Health Plan Medical-Cal (SFHP) and pre-authorizations are sent directly to SFHP by PCP office for approval. 
PCP documents in progress note what facial/body areas need treatment & makes a simple statement regarding medically necessary treatment for gender dysphoria. 

  • PCP office submits a prior authorization directly to San Francisco Health Plan for one of the rendering providers listed below, including a copy of the progress note. 
  • SFHP approves & typically sends an authorization to the rendering provider and patient. 

Healthy SF only covers surgical site hair reduction in preparation for genital surgery, for which GHSF manages a waitlist. GHSF will send a direct referral to the Gender Confirmation Center laser hair services department upon referral for genital surgery, considering the current waitlist. 

Current hair reduction providers: 

  • Fringe Electrolysis 
  • Gender Confirmation Center laser hair services 
  • Dimitra's Electrolysis 
  • Hearten Electrolysis 

Behavioral Health: Pre-Surgical Assessments

Gender Health SF’s presurgical assessment (PSA) is designed to cover both insurance approval needs by focusing on medical necessity and best outcomes for patients by focusing on informed consent, stability and readiness for surgery. The PSA needs to be completed and sent to the primary care provider prior to referral submission. The PSA is based on WPATH SOC7. The PSA (or a comparable letter) needs to be completed by a licensed mental health provider (or associate mental health providers co-signed by a licensed provider who has also met with the patient.) . See Clinical Resources for more information and links to the presurgical assessment forms.


Gender Health SF Services

Patient focus:

  • Peer Led Navigation
  • Gender Affirming Surgery Education, Preparation, Planning (EPPs)
  • Gender Affirming Surgery Care Coordination
  • Patient Wellness
  • Support Groups
    • Post-op Vaginoplasty Group: Please contact mainline for more information
      • In English 2nd Wednesday of the Month (5-6:30 pm via Zoom)
      • In Spanish 4th Wednesday of the Month (5-6:30 pm via Zoom)

Clinician and system focus:

  • Clinical Consultations
  • Provider Trainings
  • Capacity building
  • Transgender and Nonbinary workforce development



Gender Health SF
San Francisco Department of Public Health
628.206.7979 Main Line | 629.206.7999 Fax
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