Get the free ohsu clinic referral form

Hospitals & Clinics OSU ADULT PSYCHIATRY CLINIC Mail code: OP02 3181 S.W. Sam Jackson Park Portland, OR 97239-3098 tel 503 494-8617 fax 503 494-6170 REFERRAL FORM Thank you for choosing Adult Outpatient

How to fill out ohsu clinic referral form

To fill out the OHSU Clinic Referral Form, follow these steps:

1. Obtain the form: You can request the referral form from OHSU Clinic by contacting their office or visiting their website.
2. Provide personal details: Fill in your personal information such as your full name, date of birth, address, phone number, and email address. Make sure all information is accurate and up to date.
3. Specify the referring physician: Indicate the name and contact information of the physician referring you to OHSU Clinic. This information is crucial for proper coordination and communication between healthcare providers.
4. Describe the reason for referral: In this section, provide a detailed description of your medical condition or the reason why you are seeking care at OHSU Clinic. Include any relevant medical history and symptoms, as well as any previous treatments or tests you have undergone.
5. Include supporting documents: Attach any supporting documentation or medical records that may be relevant to your referral. This can include test results, imaging reports, specialist consultation notes, or any other relevant information that can help the attending physician at OHSU Clinic assess your case.
6. Specify desired appointment type: Choose the type of appointment you are requesting, such as an initial consultation, a follow-up visit, or a specific procedure. If you have a preferred date or time for your appointment, you can also indicate it in this section.
7. Provide insurance information, if applicable: If you have insurance coverage, provide your insurance details, including the name of your provider, policy number, and group number. This ensures accurate billing and reduces any potential financial complications.

Who needs the OHSU Clinic Referral Form?

1. Patients who have been referred to OHSU Clinic by their primary care physician or another healthcare provider.
2. Individuals seeking specialized medical care or consultation at OHSU Clinic for specific conditions, treatments, or procedures.
3. Patients with complex medical conditions that require the expertise and resources available at OHSU Clinic.
4. Individuals seeking a second opinion or specialized care not available at their current healthcare facility.

Remember that the requirements to fill out the referral form may vary depending on the specific policies and procedures of OHSU Clinic. It is always recommended to review any additional instructions or requirements provided by the clinic when completing the form.

People Also Ask about ohsu clinic referral form

What is the fax number for OHSU referral?

Fax referrals: Send forms and patient records to 503-346-6854.

What is a patient referral form?

A referral, in the most basic sense, is a written order from your primary care doctor to see a specialist for a specific medical service. Referrals are required by most health insurance companies to ensure that patients are seeing the correct providers for the correct problems.

What is the phone number for OHSU referral?

If you don't see your referral or need help: Call 503-494-4567 and choose option 4.

How do I get a referral to OHSU?

For questions about a referral or to seek advice from an OHSU provider, call: 503-494-4567.

What is a referral template?

Vendors and suppliers can provide this template to customers to encourage them to make referrals to other businesses who may benefit from their goods or services. The template lists the name and contact information of the business providing the referral, as well as detailed vendor info.

How do I create a patient referral form?

How to make a referral form template? Open a new document in any type of word processing software. Create a header which says “Referral Form” at the top of the page. Create the most important fields including the name of the person and his contact details. Create fields for the details about the referral.

For pdfFiller’s FAQs

What is ohsu clinic referral form?

The OHSU (Oregon Health & Science University) clinic referral form is a document used to request a referral to a specific clinic or specialist at OHSU. It is typically completed by a primary care physician or another healthcare provider who believes that a patient's medical condition requires specialized care. The referral form gathers information about the patient, their medical history, the reason for the referral, and any supporting documentation. Once completed, the form is submitted to the OHSU clinic, where it is reviewed by the appropriate healthcare provider to determine if the referral is necessary and appropriate.

Who is required to file ohsu clinic referral form?

The required party to file an OHSU (Oregon Health & Science University) clinic referral form may vary depending on the specific circumstances. Generally, it is the responsibility of the referring healthcare provider or physician to complete and submit the referral form on behalf of their patient. However, it is advisable to consult with the specific clinic or healthcare facility for their requirements and procedures regarding referral forms.

How to fill out ohsu clinic referral form?

Filling out an OHSU clinic referral form is a straightforward process. Here are the steps you can follow: 1. Obtain the referral form: Contact the OHSU clinic or healthcare provider who is referring you to the OHSU clinic and ask for the referral form. They may provide it to you in person, via email, or through their website. 2. Read the instructions: Review the instructions provided on the referral form carefully. This will help you understand the specific requirements and information needed. 3. Personal information: Start by filling in your personal information. This typically includes your full name, date of birth, address, phone number, and email address. Make sure to provide accurate and up-to-date contact details. 4. Referring healthcare provider information: Provide the details of the healthcare provider who is referring you to the OHSU clinic. This should include their name, clinic name, contact details, and any relevant identification numbers they have (such as their NPI number). 5. Insurance information: Fill in your insurance information, including your insurance provider's name, policy number, group number, and any necessary authorizations or pre-approvals. 6. Medical history: Provide all relevant medical information on the referral form. This may include your current medical conditions, previous diagnoses, medications you are taking, allergies, and any prior treatment you have received. 7. Reason for referral: Clearly state the reason for your referral to the OHSU clinic. This could be a specific medical condition you need assistance with or a requested specialist or service. 8. Additional documentation: If necessary, attach any supporting documents, such as medical reports, test results, or relevant imaging or lab reports. Ensure that these documents are organized and labeled appropriately. 9. Review and sign: Go through the completed referral form to ensure all the information is accurate and complete. Then sign and date the form as required. 10. Submit the form: Follow the instructions provided on the referral form to submit it. This may involve either mailing, faxing, emailing, or hand-delivering the completed form to the appropriate OHSU clinic or department. Always keep a copy of the completed referral form for your records, and if you have any questions or need assistance, don't hesitate to reach out to the healthcare provider or the OHSU clinic.

What is the purpose of ohsu clinic referral form?

The purpose of the OHSU (Oregon Health & Science University) clinic referral form is to facilitate the referral process for patients who need specialized medical care or consultation from a specific department or specialist within the OHSU healthcare system. The form is typically filled out by a primary care physician or another healthcare provider who wants to refer a patient to OHSU for further evaluation or treatment. It helps ensure all necessary information is conveyed to the appropriate department and aids in the efficient coordination of care between the referring physician and the OHSU clinic.

What information must be reported on ohsu clinic referral form?

The specific information required on an OHSU clinic referral form may vary depending on the clinic and the specific needs of the patient. However, typically the following information is important to include: 1. Patient's personal details: Full name, address, contact number, date of birth, and gender. 2. Referring provider's details: Full name, clinic/organization name, address, contact number, and fax number. 3. Reason for referral: A clear and concise description of the patient's medical condition or reason for seeking specialty care. 4. Medical history: Relevant medical information, such as previous diagnoses, treatments, surgeries, medications, and allergies. 5. Relevant test results: Any recent lab reports, imaging studies, or test findings that support the need for the referral. 6. Current medications: A list of all medications the patient is currently taking, including dosage and frequency. 7. Insurance information: The patient's insurance provider, policy number, and any necessary authorization or referral numbers. 8. Any additional relevant information: Any other important information or specific requests that should be considered by the receiving clinic. It is always recommended to check with the specific OHSU clinic or healthcare provider for their specific referral form requirements, as they may have additional or unique information that they require.

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