Get the free Fax New Patient Referral Form - Indiana University Health - iuhealth

Team:Bariatric Fax New Patient Referral Form Attention: Kyle Bach man From: Fax number: 5745371034 Today's Date: Total pages, including cover: Phone number: Please complete this form and fax. All

How to fill out fax new patient referral

How to fill out fax new patient referral:

1. Begin by obtaining the necessary referral form from the healthcare provider or facility that requires it.
2. Fill in the patient's demographic information, including their full name, date of birth, address, and contact details.
3. Provide the referring healthcare provider's information, such as their name, contact information, and specialty.
4. Indicate the reason for the referral, including any specific medical conditions or concerns that need to be addressed.
5. Include pertinent medical history, such as previous diagnoses, treatments, and medications, if applicable.
6. If required, attach any relevant supporting documents, such as lab results or imaging reports.
7. Double-check all the information provided to ensure accuracy and completeness.
8. Sign and date the referral form, as necessary.
9. Follow the instructions provided by the healthcare provider or facility on how to submit the referral, which may involve faxing it to a specific number.

Who needs fax new patient referral?

1. Healthcare providers or facilities that require a formal referral for new patients.
2. Specialists who need additional information about a patient's medical history or condition before accepting them for treatment.
3. Insurance companies that require a referral for coverage purposes.
4. Patients who have been advised by their primary care physician to see a specialist and need a referral to make an appointment.
5. Employers or institutions that require documentation of a referral before allowing an employee or student to seek medical treatment.

For pdfFiller’s FAQs

What is fax new patient referral?

Fax new patient referral is a form used to refer a new patient to a healthcare provider via fax.

Who is required to file fax new patient referral?

Healthcare professionals and providers are required to file fax new patient referral.

How to fill out fax new patient referral?

Fax new patient referral can be filled out by providing patient information, reason for referral, and any relevant medical history.

What is the purpose of fax new patient referral?

The purpose of fax new patient referral is to initiate the process of transferring a new patient to a healthcare provider for treatment.

What information must be reported on fax new patient referral?

Information such as patient demographics, reason for referral, referring provider information, and any relevant medical records must be reported on fax new patient referral.

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