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State of CaliforniaHealth and Human Services Agency Department of Health Care Services FAX TO: (213) 7638666 NEWBORN REFERRAL (NOT AN APPLICATION FOR MEDICAL) (PLEASE USE INK AND PRESS FIRMLY.) The

How to fill out newborn referral not an

How to fill out newborn referral not an:

1. Begin by obtaining a blank newborn referral form from the appropriate healthcare provider or agency.
2. Enter the relevant personal information of the newborn, such as their name, date of birth, and gender.
3. Fill in the contact information of the parents or legal guardians, including their names, address, phone number, and email.
4. Provide details about the referral, including the reason for the referral and any specific concerns or medical conditions the newborn may have.
5. Indicate the preferred healthcare provider or specialist to whom the referral is being made.
6. Include any additional supporting documentation or medical reports that may be required for the referral.
7. Review the completed form for accuracy and completeness before submitting it to the appropriate healthcare provider or agency.

Who needs newborn referral not an?

1. Parents or legal guardians of newborns who require specialized medical care or attention may need to fill out a newborn referral form.
2. Healthcare providers, such as pediatricians or obstetricians, who identify a need for additional evaluation or treatment for a newborn may also initiate the referral process.
3. Agencies or organizations involved in the care and support of newborns, such as social services or early intervention programs, may require a referral to access their services.

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What is newborn referral not an?

Newborn referral is not an immunization record.

Who is required to file newborn referral not an?

Healthcare providers are required to file newborn referral not an.

How to fill out newborn referral not an?

Newborn referral not an can be filled out online or submitted in person at a healthcare facility.

What is the purpose of newborn referral not an?

The purpose of newborn referral not an is to document the birth of a new baby and provide information to healthcare providers.

What information must be reported on newborn referral not an?

Information such as baby's name, date of birth, parents' names, and contact information must be reported on newborn referral not an.