Get the free TAVI Referral Form - Vancouver Island Health Authority

Name: M DOB: Royal Jubilee Hospital Transcatheter Valve Program Heart Path Lab 1952 Bay Street Victoria BC, V6Z 1Y6 Tel: 2503708111 ext 12142 Fax: 2503708736 F PhD: Address: City: Postal code: Telephone

How to fill out tavi referral form

How to fill out a TAVI referral form:

1. Start by gathering all the necessary information, such as the patient's personal details (name, age, address, contact information) and medical history.
2. Ensure you have the patient's consent to fill out the referral form on their behalf.
3. Identify the referring healthcare professional or institution, providing their contact details and any relevant identification numbers.
4. Include the reason for the TAVI referral, which may involve a detailed description of the patient's cardiovascular condition and the justification for considering a transcatheter aortic valve implantation.
5. Attach any relevant medical reports, diagnostic test results, or imaging studies that support the referral.
6. If other specialists have been involved in the patient's care, provide their names, contact information, and any pertinent information about their recommendations or treatment plan.
7. Indicate any specific timelines or urgency for the referral, if applicable.
8. Double-check all the information provided on the referral form for accuracy and completeness before submitting it to the relevant department or healthcare professional.
9. Keep a copy of the completed referral form for your records and to facilitate communication with the healthcare team involved in the patient's care.

Who needs a TAVI referral form:

A TAVI referral form may be needed by patients who have been diagnosed with severe aortic stenosis (a narrowing of the heart valve) and are being considered for a transcatheter aortic valve implantation procedure. This form is typically filled out by healthcare professionals involved in the patient's care, such as cardiologists, cardiac surgeons, or primary care physicians, to refer the patient to specialized TAVI centers or heart institutes. The referral form helps to ensure that the patient's medical history, diagnostic results, and specialist recommendations are adequately communicated to the receiving healthcare team, facilitating a smooth transition and the initiation of appropriate treatment options.

For pdfFiller’s FAQs

What is tavi referral form?

The tavi referral form is a document used to refer patients for Transcatheter Aortic Valve Implantation (TAVI) procedure.

Who is required to file tavi referral form?

Cardiologists and other healthcare professionals are required to file the tavi referral form.

How to fill out tavi referral form?

The tavi referral form can be filled out by providing patient information, medical history, and reasons for referral.

What is the purpose of tavi referral form?

The purpose of the tavi referral form is to facilitate the referral process for patients needing TAVI procedure.

What information must be reported on tavi referral form?

The tavi referral form must include patient demographics, medical history, current medications, and reasons for referral.

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