Get the free Travel Service Clinic Referral Form.pdf - UNC School of Medicine - med unc
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Travel Service Clinic Referral Form Travel Clinic Codes 755- Resource Group NU0755 Resource Date: / / Patient Name: MR #: Phone: () DOB: / / 1. Do you have a continuing care physician at UNC Internal
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What is travel service clinic referral?
Travel service clinic referral is a document that refers individuals to specific clinics or healthcare providers that offer travel-related medical services.
Who is required to file travel service clinic referral?
Travel service clinic referral is typically filed by travel agencies or companies that provide travel-related services.
How to fill out travel service clinic referral?
To fill out a travel service clinic referral, you need to provide the necessary details about the individual or group traveling, including travel dates, destinations, and any specific medical requirements. Additionally, you need to include the contact information of the recommended clinic or healthcare provider.
What is the purpose of travel service clinic referral?
The purpose of a travel service clinic referral is to ensure that individuals traveling receive appropriate medical care and advice related to their travel destinations. It helps facilitate access to specialized healthcare services for travelers.
What information must be reported on travel service clinic referral?
The travel service clinic referral should include information such as the traveler's name, contact details, travel itinerary, specific medical conditions or requirements (if any), and the recommended clinic or healthcare provider's contact information.
How can I send travel service clinic referral to be eSigned by others?
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