Get the free REFERRAL TO VASCULAR ACCESS CLINIC - BC Renal Agency

Add Health Authority Logo Add Name & Address of Vascular Access Clinic Add Addressograph/Label Phone #: Fax #: ATTENTION: VASCULAR ACCESS ...

How to fill out referral to vascular access

How to fill out referral to vascular access:

1. Begin by providing the patient's demographic information, including their full name, date of birth, and contact information.
2. Indicate the reason for the referral to vascular access, such as the need for dialysis or a vascular intervention.
3. Specify the healthcare provider who is requesting the referral and their contact information.
4. Include relevant medical history, such as any previous vascular access procedures or complications.
5. Mention any current medications the patient is taking that may impact the vascular access procedure.
6. Provide any additional information or special instructions that may be important for the healthcare provider to know.
7. Clearly indicate the urgency of the referral, if applicable.
8. Sign and date the referral form.

Who needs referral to vascular access?

1. Patients with end-stage renal disease who require hemodialysis may need a referral to vascular access.
2. Individuals with peripheral arterial disease who require revascularization procedures may require a referral to vascular access.
3. Patients with central venous access needs, such as those undergoing chemotherapy or receiving long-term intravenous medication, may need a referral to vascular access.
4. Individuals with any other vascular disease or conditions that require access to the circulatory system may require a referral to vascular access.
5. It is important to consult with a healthcare provider to determine if a referral to vascular access is necessary based on the specific patient's condition and treatment plan.

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