Get the free Obstetrical Outpatient Clinic Referral form

19353(Rev201505) Obstetrical Outpatient Clinic Referral Please complete all sections and fax to 780.791.6183 Gravid Para Estimated Date of Confinement

How to fill out obstetrical outpatient clinic referral

How to fill out obstetrical outpatient clinic referral:

1. Obtain the referral form: Start by obtaining the obstetrical outpatient clinic referral form from your healthcare provider, hospital, or clinic. This form is typically provided by the healthcare professional who is making the referral.
2. Fill in personal information: Begin by filling in your personal information on the referral form. This may include your full name, date of birth, address, contact number, and any relevant medical or insurance information. Make sure to provide accurate and up-to-date information to ensure proper communication and coordination of your care.
3. Provide details about the referring healthcare professional: Identify the healthcare professional who is referring you to the obstetrical outpatient clinic. Include their name, specialty, contact information, and any pertinent details that may aid in the referral process.
4. Include relevant medical history: Provide a brief overview of your medical history, particularly any details that may be relevant to the obstetrical outpatient clinic. This may include previous pregnancies, complications, medical conditions, allergies, or any specific concerns you may have. This information will help the obstetrical team customize your care and address any potential risks or issues.
5. Specify reason for referral: Clearly state the reason for your referral to the obstetrical outpatient clinic. Whether it is for routine prenatal care, high-risk pregnancy management, genetic counseling, or any other specific reason, ensure that it is clearly communicated on the form. This will help the clinic prioritize and schedule your appointment accordingly.

Who needs obstetrical outpatient clinic referral?

1. Pregnant women: Women who are pregnant and require specialized obstetric care should obtain an obstetrical outpatient clinic referral. This referral may be obtained from their primary healthcare provider, obstetrician, or midwife.
2. Women with high-risk pregnancies: Women with high-risk pregnancies, such as those with medical conditions (diabetes, hypertension, etc.), previous pregnancy complications, advanced maternal age, or multiple gestations (twins, triplets, etc.), may require referral to an obstetrical outpatient clinic. This allows for closer monitoring, specialized care, and management of any potential complications.
3. Women seeking genetic counseling: Women who have concerns about their genetic health or wish to discuss potential genetic issues in their family may be referred to an obstetrical outpatient clinic for genetic counseling. This referral enables access to specialized healthcare professionals who can provide guidance, information, and testing options related to genetic conditions.
4. Women with specific obstetric concerns: Women who have specific obstetric concerns, such as abnormal ultrasound findings, suspected fetal abnormalities, or previous birth trauma, may be referred to an obstetrical outpatient clinic for further evaluation, consultations, or specialized services.

In summary, to fill out an obstetrical outpatient clinic referral, you need to obtain the referral form, provide personal information, details about the referring healthcare professional, relevant medical history, and specify the reason for the referral. Obstetrical outpatient clinic referrals are typically needed by pregnant women, those with high-risk pregnancies, women seeking genetic counseling, and those with specific obstetric concerns.

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What is obstetrical outpatient clinic referral?

Obstetrical outpatient clinic referral is a request made by a healthcare provider to refer a pregnant woman to an outpatient clinic for obstetrical care.

Who is required to file obstetrical outpatient clinic referral?

Obstetrical outpatient clinic referral can be filed by any healthcare provider involved in the care of the pregnant woman, such as a primary care physician, obstetrician, or midwife.

How to fill out obstetrical outpatient clinic referral?

To fill out an obstetrical outpatient clinic referral, the healthcare provider must provide the necessary information about the pregnant woman's medical history, current pregnancy status, and reason for referral.

What is the purpose of obstetrical outpatient clinic referral?

The purpose of obstetrical outpatient clinic referral is to ensure that pregnant women receive appropriate care and support from specialized healthcare providers in an outpatient setting.

What information must be reported on obstetrical outpatient clinic referral?

Information that must be reported on obstetrical outpatient clinic referral includes the pregnant woman's name, age, due date, medical history, current pregnancy status, and reason for referral.