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THE GEORGIA GASTROENTEROLOGY CENTER 1014 Forsyth Street, Suite 300 Macon, Georgia 31201 Office: (478) 6338700 Fax: (478) 6338710 William K. Tackler, M. D Joel R. Judah, M.D. Tina M. Murray, NPC Adam
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Start by opening the document on your computer or printing out a physical copy.
02
Begin by filling in the header section, which usually includes the date, your name, and contact information.
03
Look for the specific sections where you need to provide information about the patient. This may include their name, address, contact information, and any relevant medical history.
04
Proceed to fill out the details of the referral. This typically involves specifying the reason for the referral, the recommended provider, and any additional notes or instructions.
05
Double-check all the information you have entered to ensure accuracy and completeness.
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Sign and date the referral request in the appropriate section.
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If required, submit the completed form as instructed - you may need to send it via email, fax, or physically deliver it to the intended recipient.

Who needs grouppracticereferralrequest7-101doc - navicenformalth:

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Medical practitioners or healthcare professionals who wish to refer a patient to another provider or specialist.
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Patients who require specialized care or treatment that their primary care provider is unable to provide.
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Managed care organizations or insurance companies who require a formal referral for coverage or reimbursement purposes.
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This document is a referral request form used within a medical group practice.
Healthcare providers in a medical group practice are required to file this referral request form.
The form should be filled out with the patient's information, reason for referral, referring provider information, and any other relevant details.
The purpose of this form is to facilitate the referral process within a medical group practice.
Patient details, reason for referral, referring provider information, and any relevant medical history must be reported on this form.
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