Get the free STROKE PREVENTION CLINIC REFERRAL *MSXX* MSXX102039D Rev: March 2015 Page: 1 of 2 FA...

STROKE PREVENTION CLINIC REFERRAL *MXX* MSXX102039D Rev: March 2015 Page: 1 of 2 Faxes to JPO CSC Central Intake (6049539701) NOTE: FAX STROKE PREVENTION CLINIC REFERRAL with this form PATIENT INFORMATION:

How to fill out stroke prevention clinic referral

How to fill out a stroke prevention clinic referral:

1. Contact your primary care physician to discuss your concerns about stroke prevention and ask for a referral to a stroke prevention clinic.
2. Your primary care physician will provide you with a referral form or guide you on how to obtain one.
3. Fill out the referral form, providing accurate and detailed information about your medical history, current medications, and any previous stroke-related events or symptoms.
4. Make sure to include your personal contact information so that the clinic can reach out to you for further appointments or information if needed.
5. If there are any specific tests or assessments you would like the stroke prevention clinic to perform or focus on, make a note of it on the referral form.
6. Once you have completed the referral form, submit it to your primary care physician's office either in person, by mail, or through electronic means.
7. Your primary care physician will review the referral form and send it to the stroke prevention clinic.
8. Keep a copy of the referral form for your records.

Who needs a stroke prevention clinic referral:

1. Individuals who have a family history of stroke or genetic predisposition to stroke.
2. People who have experienced symptoms of a previous stroke or transient ischemic attack (TIA).
3. Individuals with risk factors for stroke, such as high blood pressure, diabetes, high cholesterol, or atrial fibrillation.
4. Patients who have undergone certain medical procedures or surgeries that increase their risk of stroke.
5. Older adults who want to assess their overall stroke risk and take preventative measures.
6. Anyone who is concerned about their risk of stroke and wants expert evaluation and guidance from a specialized clinic.

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What is stroke prevention clinic referral?

A stroke prevention clinic referral is a recommendation to refer a patient to a specialized clinic for the prevention and management of strokes.

Who is required to file stroke prevention clinic referral?

Healthcare providers, such as primary care physicians and neurologists, are required to file stroke prevention clinic referrals.

How to fill out stroke prevention clinic referral?

To fill out a stroke prevention clinic referral, healthcare providers need to provide information about the patient's medical history, risk factors for stroke, and reason for the referral.

What is the purpose of stroke prevention clinic referral?

The purpose of a stroke prevention clinic referral is to ensure that patients at risk for strokes receive timely and appropriate care to prevent future stroke events.

What information must be reported on stroke prevention clinic referral?

Information such as patient demographics, medical history, current medications, risk factors for stroke, and reason for referral must be reported on a stroke prevention clinic referral.