Get the free Department of Neurology Referral Intake Form - ohsu

Form used for referring patients to the OHSU Department of Neurology, including details on patient information and clinical questions.

How to fill out department of neurology referral

How to fill out Department of Neurology Referral Intake Form

1. Obtain the Department of Neurology Referral Intake Form from the hospital or clinic's website or front desk.
2. Fill out the patient's personal information, including full name, date of birth, and contact details.
3. Provide the referring physician's details, including name, contact information, and specialty.
4. Indicate the reason for the referral, including specific symptoms or concerns related to neurological health.
5. Include any relevant medical history and previous treatments related to the patient's condition.
6. Attach any necessary medical documents or test results that might aid in the evaluation.
7. Review the form for accuracy and completeness before submission.
8. Submit the form via the designated method, whether electronically or in person.

Who needs Department of Neurology Referral Intake Form?

1. Patients experiencing neurological symptoms or conditions that require specialized evaluation.
2. Primary care physicians or general practitioners who are referring patients to a neurologist for further assessment.
3. Caregivers or family members helping a patient who requires neurology services.

People Also Ask about

What is an urgent neurology referral?

Consider urgent referral (to an appropriate specialist) in patients with rapid progression of: sub acute focal neurological deficit. unexplained cognitive impairment, behavioural disturbance or slowness, or a combination of these.

Can I ask to be referred to a neurologist?

This must be done through your GP or consultant. He or she will rarely refuse to refer you unless there is a sufficient reason. A private appointment can speed up the process and avoids waiting lists. You can contact a private consultant yourself, or ask for a referral from your GP.

How do you get referred to a neurologist?

Neurologists diagnose and treat medical conditions that affect the nervous system. A general practice doctor may refer a person to a neurologist if they show signs of a neurological disorder, such as: persistent or severe headaches. muscle weakness.

How do you get referred to a neurology?

Neurologists diagnose and treat medical conditions that affect the nervous system. A general practice doctor may refer a person to a neurologist if they show signs of a neurological disorder, such as: persistent or severe headaches. muscle weakness.

Who is the chief of neurology at the University of Chicago?

Shyam Prabhakaran, MD, MS.

How to get a referral to see a neurologist?

You should understand that you must have a referral from your doctor before visiting a neurologist. Any certificate or document certifying the disease is necessary for a neurologist appointment. When you receive a particular document, you should make an appointment yourself or call the clinic.

What symptoms require a neurologist?

When should I make an appointment with a neurologist? Memory disturbances, forgetfulness. Loss of consciousness. Seizures. Taste or smell disturbances. Vision problems. Numbness and tingling sensations. Facial asymmetries (one side of your face doesn't match the other [eyelid droops, can't fully smile]).

For pdfFiller’s FAQs

What is Department of Neurology Referral Intake Form?

The Department of Neurology Referral Intake Form is a document used by healthcare providers to facilitate the referral of patients to a neurology department for evaluation and treatment.

Who is required to file Department of Neurology Referral Intake Form?

Any healthcare provider or professional referring a patient to the Department of Neurology is required to file the Department of Neurology Referral Intake Form.

How to fill out Department of Neurology Referral Intake Form?

To fill out the Department of Neurology Referral Intake Form, a healthcare provider must complete all required fields, including patient information, referring physician details, and the reason for referral, and submit it as per the department's guidelines.

What is the purpose of Department of Neurology Referral Intake Form?

The purpose of the Department of Neurology Referral Intake Form is to gather necessary information about the patient and their condition to ensure appropriate triage and management by the neurology team.

What information must be reported on Department of Neurology Referral Intake Form?

The information that must be reported on the Department of Neurology Referral Intake Form includes patient demographics, medical history, medications, symptoms, and any relevant diagnostic tests.