Get the free doernbecher referral form - ohsu

Doernbecher Referral Form Thank you for referring your patient to OSU Doernbecher Children’s Hospital. Please indicate the specialty to which you are referring your patient: n Audiology n Metabolism

How to fill out doernbecher referral form

How to fill out the doernbecher referral form:

1. Start by gathering all the necessary information about the patient for whom you are referring. This includes their personal details such as name, age, address, and contact information.
2. Complete the medical history section of the form, providing details about the patient's previous medical conditions, medications, allergies, and any other relevant information.
3. Fill out the reason for referral section, clearly explaining why the patient needs to be referred to Doernbecher hospital. Provide a detailed explanation of the symptoms, diagnosis, or any other pertinent information that supports the need for referral.
4. If applicable, include any additional documents or reports that could support the referral, such as lab results, imaging reports, or specialist consultation notes.
5. Complete the referring healthcare provider information section, including your name, professional title, contact information, and any other required details.
6. Review the completed referral form for accuracy and completeness before submitting it to Doernbecher hospital.

Who needs the Doernbecher referral form:

1. Patients who require specialized medical care that cannot be provided at their current healthcare facility may need the Doernbecher referral form.
2. Healthcare providers who believe that their patient's condition would benefit from the expertise and resources available at Doernbecher hospital may need to fill out the referral form.
3. Families of pediatric patients seeking specialized care and treatment options for their children may need to complete the Doernbecher referral form.

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What is doernbecher referral form?

The Doernbecher referral form is a document used to refer patients to Doernbecher Children's Hospital for specialized pediatric care.

Who is required to file doernbecher referral form?

The Doernbecher referral form is typically required to be filed by healthcare providers or physicians who are referring a patient to the hospital for evaluation or treatment.

How to fill out doernbecher referral form?

To fill out the Doernbecher referral form, the referring physician must provide patient information, details about the medical condition, and any relevant medical history, along with their contact information and the reason for referral.

What is the purpose of doernbecher referral form?

The purpose of the Doernbecher referral form is to streamline the referral process, ensuring that all necessary patient information is collected and communicated to facilitate prompt evaluation and care.

What information must be reported on doernbecher referral form?

The Doernbecher referral form must include patient demographics, medical history, current medications, details of the presenting problem, and the referring physician's contact information.