Get the free CHDP Chest X-Ray Referral Form - ochcacom

County of Orange Health Care Agency Pulmonary Disease Services CHIP Chest Ray Referral Form CLIENTS MUST BE RESIDENTS OF ORANGE COUNTY TO BE ELIGIBLE FOR CHEST RAY SERVICES. Clients must present this

How to fill out chdp chest x-ray referral

How to fill out a CHDP chest x-ray referral:

1. Start by filling out the patient's personal information, including their full name, date of birth, and contact information.
2. Provide the patient's medical history, including any relevant information regarding previous chest x-rays or respiratory conditions.
3. Indicate the reason for the referral, whether it is for a routine check-up, investigation of a specific condition, or follow-up examination.
4. Specify the referring healthcare provider's information, including their name, contact details, and any necessary identification numbers.
5. Include any additional notes or comments regarding the referral, such as urgency or specific instructions for the radiology center.
6. Make sure to review the completed referral form for accuracy and legibility before submitting it.

Who needs a CHDP chest x-ray referral:

1. Pediatric patients who are enrolled in the California Children's Services (CCS) program may require a CHDP chest x-ray referral.
2. Children with symptoms or risk factors for respiratory conditions, such as persistent cough, asthma, or exposure to pollutants, may also need a CHDP chest x-ray referral.
3. Additionally, children who have previously received abnormal results from a chest x-ray or who are undergoing treatment for a respiratory condition may require a CHDP chest x-ray referral for monitoring and follow-up.

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What is chdp chest x-ray referral?

CHDP chest x-ray referral is a form used to refer children to receive chest x-ray screening as part of the Child Health and Disability Prevention Program.

Who is required to file chdp chest x-ray referral?

Healthcare providers, such as physicians, nurse practitioners, and clinics, are required to file CHDP chest x-ray referrals for eligible children.

How to fill out chdp chest x-ray referral?

To fill out a CHDP chest x-ray referral, healthcare providers need to include the child's information, reason for referral, and provider information.

What is the purpose of chdp chest x-ray referral?

The purpose of CHDP chest x-ray referral is to identify and monitor chest conditions in children for early detection and treatment.

What information must be reported on chdp chest x-ray referral?

Information such as child's name, date of birth, reason for referral, provider's name, and contact information must be reported on CHDP chest x-ray referral.