Get the free CR OB Referral Form - rev 2014-01-05 - - crossroadsobgyn

330507 West Broadway Ave Vancouver, BC V5Z 1E6 t 604.872.5484 or 604.708.0788 www.crossroadsobgyn.ca REFERRAL FORM OBSTETRICS Your office will be informed of appointment date and time. The patient

How to fill out cr ob referral form

Who needs a CR OB referral form?

1. Obstetricians or gynecologists: Obstetricians and gynecologists need a CR OB referral form to refer their patients to specialized care for high-risk pregnancies or specific obstetric conditions. This form allows them to communicate important medical information and ensure necessary follow-up care.
2. Patients with high-risk pregnancies: Women who have been identified as having a high-risk pregnancy may receive a CR OB referral form from their obstetrician. These patients may have pre-existing medical conditions, multiple pregnancies, or complications that need specialized care from a maternal-fetal medicine specialist.
3. Women with specific obstetric conditions: Some obstetric conditions, such as placenta previa or fetal malformations, require special attention and care. In these cases, the obstetrician may refer the patient to a specialist using a CR OB referral form to ensure appropriate management and coordination of care.

How to fill out a CR OB referral form?

1. Patient's information: Start by providing the patient's personal details, including their full name, date of birth, contact information, and any relevant identification numbers (such as health insurance or medical record numbers).
2. Referring physician's information: Enter the name, contact details, and medical license number of the referring obstetrician or gynecologist. This information helps establish a clear line of communication between the referring physician and the specialist.
3. Reason for referral: Clearly indicate the reason for the referral. Describe the high-risk pregnancy, specific obstetric condition, or concerns that necessitate specialized care. Include relevant medical history, test results, or diagnostic findings to provide the specialist with a comprehensive understanding of the patient's condition.
4. Preferred specialist or facility: If the referring physician has a specific specialist or facility in mind, it is crucial to mention their name, contact information, and any specific requirements for the referral. Otherwise, leave this section blank for the specialist to determine the most appropriate referral destination.
5. Urgency of the referral: Indicate whether the referral is routine, urgent, or emergent. This helps the specialist understand the level of priority and plan accordingly. If there is a need for immediate attention, specify the reason for urgency.
6. Additional information or instructions: Use this section to provide any other relevant information or specific instructions related to the referral, such as desired time frame or any special considerations that the specialist should keep in mind.
7. Consent: Ensure that the patient has provided their informed consent for the referral, as this involves sharing their medical information with another healthcare provider or facility. This can be indicated by the patient's signature or a separate consent form attached to the referral.

Remember to double-check all the filled-out information for accuracy and legibility before submitting the CR OB referral form to the designated specialist or facility.

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What is cr ob referral form?

The cr ob referral form is a form used to report potential criminal activity or suspicious behavior to authorities.

Who is required to file cr ob referral form?

Any individual or organization that suspects criminal activity or suspicious behavior is required to file a cr ob referral form.

How to fill out cr ob referral form?

The cr ob referral form can be filled out electronically or manually with all relevant information about the suspected criminal activity or behavior.

What is the purpose of cr ob referral form?

The purpose of the cr ob referral form is to alert authorities to potential criminal activity so that they can investigate and take appropriate action.

What information must be reported on cr ob referral form?

The cr ob referral form must include details about the suspected criminal activity or behavior, as well as any supporting evidence or documentation.