Get the free AFibUHWarfarin Clinic Referral Form Sept 2008doc

Atrial Fibrillation Oral Anticoagulation Clinic at University Hospital Referral Form Date of referral: Patient Name: Health Card or PIN: Referring Physician: Referring Physician Contact Phone #: Reason

How to fill out afibuhwarfarin clinic referral form

How to Fill Out an Afibuhwarfarin Clinic Referral Form:

1. Begin by carefully reading the instructions provided on the referral form. Make sure you understand what information needs to be included and any specific guidelines or requirements.
2. Start by providing your personal information such as your name, date of birth, and contact details. This will help the clinic staff identify you and reach out if needed.
3. Next, indicate the reason for the referral. In this case, the referral is for an Afibuhwarfarin clinic, so specify that you are seeking specialized care related to atrial fibrillation and warfarin management.
4. If you have a primary care physician or referring doctor, include their name, contact information, and any additional details requested on the form. This will help ensure proper communication between healthcare professionals.
5. Clearly state your medical history and any relevant conditions. Provide as much detail as possible, including previous diagnoses, surgeries, medications, and allergies. This information will help the clinic understand your medical background and tailor their treatment accordingly.
6. If you have any specific concerns or symptoms related to your condition, describe them in the appropriate section of the referral form. Being detailed and specific will assist the clinic in addressing your needs effectively.
7. Include any recent test results, such as blood work or imaging reports, that are relevant to your condition. This will provide the clinic with important diagnostic information and help them make an accurate assessment of your situation.
8. If you have any questions or require any accommodations, make sure to mention them on the form. This ensures that the clinic staff is aware of your needs and can address them accordingly.

Who Needs an Afibuhwarfarin Clinic Referral Form?

1. Individuals who have been diagnosed with atrial fibrillation (Afib) and are being prescribed warfarin, a common anticoagulant medication.
2. Patients who require specialized care and monitoring for their Afib and warfarin therapy.
3. Those who are seeking consultation or treatment from clinicians who specialize in managing atrial fibrillation and warfarin use.

In summary, filling out an Afibuhwarfarin clinic referral form involves providing your personal information, specifying the reason for the referral, detailing your medical history and conditions, including relevant test results, and expressing any concerns or questions you may have. This form is typically needed by individuals with atrial fibrillation who require specialized care and monitoring related to their warfarin therapy.

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What is afibuhwarfarin clinic referral form?

The afibuhwarfarin clinic referral form is a document used to refer patients with atrial fibrillation (AFib) who are prescribed warfarin to a specialized clinic for monitoring and management.

Who is required to file afibuhwarfarin clinic referral form?

Healthcare providers, such as primary care physicians or cardiologists, who are treating patients with AFib and prescribing warfarin are required to file the clinic referral form.

How to fill out afibuhwarfarin clinic referral form?

The form typically requires information about the patient's medical history, current medications, warfarin dosage, INR levels, and reason for referral. Healthcare providers can fill out the form electronically or by hand.

What is the purpose of afibuhwarfarin clinic referral form?

The purpose of the clinic referral form is to ensure that patients with AFib who are on warfarin therapy receive specialized care and monitoring to optimize treatment outcomes and prevent complications.

What information must be reported on afibuhwarfarin clinic referral form?

The form may require details such as patient demographics, past medical history, current medications, warfarin dosage, INR levels, reason for referral, and healthcare provider's contact information.