Get the free IM-60. Medical Referral and Authorization - dss mo

MISSOURI DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISION REQUEST FOR EMPLOYMENT SECURITY INFORMATION OUTSIDE STATE OF MISSOURI OFFICE NAME TELEPHONE NUMBER FROM DATE 2013/12/27 ADDRESS (STREET)

How to fill out im-60 medical referral and

How to fill out an IM-60 medical referral and:

1. Obtain the IM-60 medical referral form - This form can typically be obtained from your healthcare provider, such as your primary care physician or specialist.
2. Fill in your personal information - Begin by filling in your full name, date of birth, address, and contact information. Ensure all information is accurate and up-to-date.
3. Provide details about your healthcare provider - Include the name, contact information, and any identification or provider number for the healthcare professional who is referring you. This may include their name, address, phone number, and specialty.
4. Specify the reason for the referral - Clearly state the specific reason why you are being referred for medical care. This may be due to a specific symptom or condition that requires further evaluation or treatment.
5. Indicate any relevant medical history - Provide details about your medical history that may be pertinent to the referral. This can include any previous diagnoses, surgeries, medications, or allergies.
6. Attach any supporting documents or test results - If you have any relevant medical records, test results, or imaging scans that support the need for the referral, attach copies to the form. This provides additional information for the healthcare professional reviewing the referral.
7. Sign and date the form - After completing all sections of the IM-60 medical referral form, ensure that you sign and date the document. This indicates your consent and understanding of the referral process.

Who needs an IM-60 medical referral and:

1. Individuals in need of specialist care - An IM-60 medical referral may be required when your primary care physician believes it is necessary to refer you to a specialist or another healthcare professional who has more specialized knowledge in a particular area.
2. Patients seeking further evaluation or treatment - If you have a specific symptom, condition, or medical concern that requires further evaluation or treatment beyond the capabilities of your primary care physician, they may recommend an IM-60 medical referral.
3. Insurance or healthcare program requirements - Some insurance providers or healthcare programs may require an IM-60 medical referral before authorizing coverage for certain procedures, treatments, or specialist visits. In these cases, obtaining a referral is necessary to ensure that the services will be covered by your insurance.

Remember, it is always important to consult with your healthcare provider to determine if an IM-60 medical referral is necessary in your specific situation. They will be able to guide you through the process and provide any additional information or instructions.

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What is im-60 medical referral and?

IM-60 medical referral is a form used to refer a patient to a specialist for medical treatment.

Who is required to file im-60 medical referral and?

Medical professionals such as doctors and healthcare providers are required to file IM-60 medical referral.

How to fill out im-60 medical referral and?

IM-60 medical referral should be filled out by providing the patient's information, medical condition, and reason for referral.

What is the purpose of im-60 medical referral and?

The purpose of IM-60 medical referral is to ensure that patients receive proper medical treatment from specialists.

What information must be reported on im-60 medical referral and?

The IM-60 medical referral must include the patient's personal information, medical history, and reason for referral.