Get the free ORAL ONCOLOGY REFERRAL FORM - Elwyn Specialty Care

ORAL ONCOLOGY REFERRAL FORM 3070 McCann Farm Drive Suite 101 Garnet Valley, PA 19060 TEL: 6105456040 FAX: 6105456030 Toll Free: 8663170672 Today's Date CURRENT PATIENT NEW PATIENT Name SS# DOB Height

How to fill out oral oncology referral form

How to fill out an oral oncology referral form:

1. Start by obtaining the referral form from the designated source, such as a hospital or healthcare facility.
2. Clearly write your personal information, including your full name, date of birth, contact details, and any relevant identification numbers, such as your healthcare insurance number.
3. Provide the name and contact information of the referring healthcare professional who is recommending the oral oncology consultation.
4. Indicate the reason for the referral by providing a brief explanation of your current oral health condition or concerns.
5. Write down any relevant medical history or allergies that could affect the oral oncology consultation or treatment process.
6. Include any supporting documentation or test results that may assist the oral oncologist in evaluating your condition, such as X-rays, biopsy results, or previous medical reports.
7. If applicable, mention any specific oral oncologist or treatment center you wish to be referred to.
8. Finally, ensure that you have signed and dated the referral form before submitting it as per the instructions provided.

Who needs an oral oncology referral form:

1. Patients who have been diagnosed with oral cancer or suspected to have oral abnormalities that require further evaluation by an oral oncologist.
2. Individuals who have been recommended by their primary care physician or dentist to seek specialized oral oncology care.
3. People who have a history of oral cancer or premalignant oral lesions and require regular follow-ups or screenings by an oral oncologist.
4. Patients who need a specialist opinion or treatment plan for complex oral conditions, including those related to oral oncology.

Remember, it is crucial to consult with a healthcare professional or your primary care physician to determine if an oral oncology referral form is necessary for your specific case.

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