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This document is a referral form for patients to be screened for spinal disorders such as scoliosis, kyphosis, and lordosis. It includes sections for patient information, parent/guardian details,

How to fill out scoliosis screening program referral

How to fill out Scoliosis Screening Program Referral Form

1. Begin by downloading or obtaining a copy of the Scoliosis Screening Program Referral Form.
2. Fill in the patient's personal information, including full name, date of birth, and contact information.
3. Indicate the reason for referral, specifying any observed symptoms or concerns.
4. Provide the patient's medical history, noting any previous conditions related to spinal health.
5. Include details of the physical examination, such as posture, spinal alignment, and any notable asymmetries.
6. Sign and date the form to confirm its accuracy and completeness.
7. Submit the completed form to the appropriate healthcare provider or facility for further evaluation.

Who needs Scoliosis Screening Program Referral Form?

1. Children and adolescents who exhibit signs of scoliosis or have a family history of scoliosis.
2. Individuals who have been identified by a healthcare professional as needing further assessment for scoliosis.
3. Students in schools participating in scoliosis screening initiatives.

For pdfFiller’s FAQs

What is Scoliosis Screening Program Referral Form?

The Scoliosis Screening Program Referral Form is a document used to refer individuals for scoliosis screening to assess the curvature of the spine and determine if further evaluation or treatment is needed.

Who is required to file Scoliosis Screening Program Referral Form?

Healthcare providers, such as doctors or school nurses, are typically required to file the Scoliosis Screening Program Referral Form when they identify a student or patient who may need scoliosis screening.

How to fill out Scoliosis Screening Program Referral Form?

To fill out the Scoliosis Screening Program Referral Form, one should provide the patient's personal information, include observations related to scoliosis, and indicate any previous assessments or treatments that have taken place.

What is the purpose of Scoliosis Screening Program Referral Form?

The purpose of the Scoliosis Screening Program Referral Form is to facilitate the identification and referral of individuals who are at risk for scoliosis, ensuring they receive proper assessment and management.

What information must be reported on Scoliosis Screening Program Referral Form?

The form must report the individual's name, age, contact information, any observed signs of scoliosis, the referring healthcare provider's details, and relevant medical history.