Get the free Wound Referral Form - Kent Hospital

WOUND RECOVERY CENTER AT KENT HOSPITAL Wound & Ostomy Care Hyperbaric Medicine 455 Toll Gate Road Warwick, RI 02886 Telephone (401) 736-4646 Fax (401) 736-4248 Patient Referral Referring Physician:

How to fill out wound referral form

How to fill out a wound referral form?

1. Begin by locating the wound referral form provided by your healthcare provider or medical facility.
2. Fill in your personal information accurately. This may include your full name, date of birth, address, contact number, and any relevant identification numbers such as your healthcare insurance or Medicare number.
3. Provide details about the wound, such as its location, size, and any related symptoms or complications. Be as specific as possible to help the healthcare professional assess your condition effectively.
4. Indicate the date the wound occurred or was noticed, as well as any relevant information about the circumstances surrounding the injury.
5. If applicable, mention any previous treatments or medications you have used for the wound and their effectiveness.
6. Describe any allergies or sensitivities you may have to certain medications or materials, as this will assist the healthcare professional in determining the most appropriate treatment for your wound.
7. If you have any pre-existing medical conditions, ensure to mention them on the form as they can have an impact on wound healing and treatment options.
8. Ensure to sign the form to indicate your consent for the healthcare professional to assess and treat your wound as necessary.
9. Submit the completed form to the appropriate medical personnel or department as instructed by your healthcare provider.

Who needs a wound referral form?

1. Individuals who have encountered a wound that requires medical attention from a specialized healthcare professional may need a wound referral form.
2. This form may be necessary for individuals who have sustained deep or severe wounds, wounds that show signs of infection or are not healing properly, or wounds that require specialized treatments such as surgical interventions or wound vac therapy.
3. The wound referral form helps ensure that the information necessary for a proper assessment and treatment plan is provided to the appropriate healthcare professional, allowing them to deliver the most effective care for the individual's specific wound condition.

For pdfFiller’s FAQs

What is wound referral form?

The wound referral form is a document used to refer a patient with a wound to a specialist for further evaluation and treatment.

Who is required to file wound referral form?

Any healthcare provider or medical professional who identifies a patient with a wound that requires specialized care can file a wound referral form.

How to fill out wound referral form?

To fill out a wound referral form, you need to provide patient information, describe the wound, mention any previous treatments, and indicate the reason for referral. The form may also require you to include your contact information and any supporting documentation.

What is the purpose of wound referral form?

The purpose of the wound referral form is to ensure that patients with complex or severe wounds receive appropriate care from specialists who have the necessary expertise and resources.

What information must be reported on wound referral form?

The wound referral form typically requires information such as patient demographics, wound details (location, size, severity, etc.), previous treatments, reason for referral, and contact information for both the referring healthcare provider and the specialist.

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