I recently switched my pcm off base but need a referreal for the orthopedic I used to just call the hopital/med clinic on base what do I do now?

you have to go and see your PCM and have them put the referral through.

Yeah, see your PCM. A civilian pcm who is in network can put in referrals just like the military doctors can. The only thing is if you are seeing a civilian ortho, make sure he is in network, sometimes civilian doctors are unaware of which specialists are in network.
I usually log in to the Tricare's website and get the authorization number for the referral to take with me, just in case the specialist's office didn't get the paperwork. If they have the auth #, they will see you.