Get the free Maternal Fetal Medicine Referral Form - UF Health Jacksonville

MaternalFetalMedicine ReferralForm CollegeofMedicineJacksonville DepartmentofObstetricsandGynecologyReferralCoordinator:Carolyn Ford, R.N. DivisionofMaternalFetalMedicine

How to fill out maternal fetal medicine referral

How to fill out maternal fetal medicine referral:

1. Obtain the referral form from your healthcare provider or the maternal fetal medicine department.
2. Fill in your personal information, including your name, address, contact number, and date of birth.
3. Provide details about your primary healthcare provider, including their name, clinic or hospital, and contact information.
4. Specify your reason for seeking a maternal fetal medicine referral. Include any relevant medical conditions, concerns, or complications during your pregnancy.
5. Indicate if you have had any previous prenatal testing or consultations related to your current pregnancy.
6. Include any relevant medical history, such as previous pregnancies, pregnancies with complications, or any genetic conditions or disorders that run in your family.
7. If applicable, provide information about any current medications or supplements that you are taking.
8. If you have any special language or communication preferences that should be considered, make note of them in the appropriate section.
9. Sign and date the referral form before submitting it to the designated maternal fetal medicine department or healthcare provider.

Who needs maternal fetal medicine referral:

1. Pregnant individuals who have been identified with high-risk factors during their pregnancy, such as advanced maternal age (35 years or older), multiple pregnancies (twins, triplets), or preexisting medical conditions like diabetes or hypertension.
2. Pregnant individuals with a history of previous pregnancy complications, such as preterm birth, gestational diabetes, preeclampsia, fetal growth restriction, or recurrent miscarriages.
3. Pregnant individuals who have been diagnosed with fetal abnormalities during routine prenatal screening or ultrasound examinations.
4. Pregnant individuals who have experienced complications in previous pregnancies or have a family history of genetic disorders or birth defects.
5. Pregnant individuals who require specialized monitoring or management due to medical conditions, such as heart disease, kidney disease, autoimmune disorders, or blood clotting disorders.
6. Pregnant individuals with concerns or questions regarding their pregnancy that may require additional expertise or specialized testing available through maternal fetal medicine.

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What is maternal fetal medicine referral?

Maternal fetal medicine referral involves referring a pregnant woman to a specialist for high-risk pregnancy care.

Who is required to file maternal fetal medicine referral?

Maternal fetal medicine referral is typically filed by the obstetrician or primary care provider overseeing the pregnancy.

How to fill out maternal fetal medicine referral?

Maternal fetal medicine referral can be filled out by providing the patient's medical history, current pregnancy status, and reason for referral.

What is the purpose of maternal fetal medicine referral?

The purpose of maternal fetal medicine referral is to ensure that pregnant women with high-risk pregnancies receive specialized care and monitoring.

What information must be reported on maternal fetal medicine referral?

Information such as the patient's medical history, current pregnancy status, and reason for referral must be reported on maternal fetal medicine referral.