Get the free ANTICOAGULATION MANAGEMENT CLINIC REFERRAL - Fraser Health

ANTICOAGULATION MANAGEMENT CLINIC REFERRAL *MXX* MSXX104191D Rev: Dec. 10×14 Page: 1 of 2 Faxes to JPO CSC Central Intake (6049539701) PATIENT INFORMATION: Patient's Name: Gender: Last Date of Birth:

How to fill out anticoagulation management clinic referral

How to fill out anticoagulation management clinic referral:

1. Obtain the referral form: Contact the anticoagulation management clinic or your healthcare provider to obtain the referral form required for the referral process.
2. Fill out the patient's demographic information: Provide the patient's full name, date of birth, contact information, and any other required details. This information helps identify the patient and ensures proper communication.
3. Indicate the reason for referral: Clearly state the reason why the patient needs to be referred to the anticoagulation management clinic. This could be due to a new diagnosis of a blood clotting disorder, the need for ongoing management of anticoagulant therapy, or any other relevant indication.
4. Include the patient's medical history: Provide a summary of the patient's relevant medical history, including previous diagnoses, surgeries, or any known contraindications or precautions related to anticoagulant therapy.
5. Include current medications: List all of the patient's current medications, including prescribed medications, over-the-counter drugs, supplements, and herbal remedies. This information helps the anticoagulation management clinic assess potential drug interactions or adjustments needed for anticoagulant therapy.
6. Attach relevant medical records: If available, include copies of relevant medical records such as recent lab results, imaging reports, or discharge summaries. These records provide additional context for the anticoagulation management clinic to make informed decisions about the patient's care.
7. Obtain necessary signatures: Ensure that the referral form is signed by the referring healthcare provider or their authorized representative. This signature confirms the authenticity of the referral and the referral source.
8. Submit the referral: Once all the necessary information is filled out and the form is complete, submit the referral to the anticoagulation management clinic through the designated method, such as fax, email, or electronic submission.

Who needs anticoagulation management clinic referral?

1. Patients with atrial fibrillation: Atrial fibrillation is a common indication for anticoagulant therapy to reduce the risk of blood clots and stroke. These patients may require a referral to an anticoagulation management clinic for ongoing evaluation and adjustment of their anticoagulant medication.
2. Individuals with venous thromboembolism: Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, often necessitates the initiation of anticoagulant therapy. Referral to an anticoagulation management clinic can help ensure appropriate management and long-term follow-up.
3. Patients with mechanical heart valves: Individuals with mechanical heart valves require anticoagulant therapy to prevent clot formation on the valve's surface. Regular monitoring and management of the anticoagulant medication are crucial in these cases, making referral to an anticoagulation management clinic essential.
4. Individuals with inherited blood clotting disorders: Certain inherited conditions, such as Factor V Leiden mutation or antiphospholipid syndrome, increase the risk of blood clot formation. Referral to an anticoagulation management clinic can help these patients receive specialized care and guidance in managing their condition.
5. Patients with recurrent blood clotting events: Individuals who have experienced recurrent blood clotting events, such as multiple deep vein thromboses, may benefit from referral to an anticoagulation management clinic. The clinic's expertise can assist in identifying underlying causes and optimizing anticoagulant therapy.

Overall, the need for an anticoagulation management clinic referral depends on the specific medical condition, the complexity of anticoagulant therapy, and the need for ongoing monitoring and adjustment of the treatment. It is important to consult with healthcare providers to determine whether a referral to an anticoagulation management clinic is appropriate for individual cases.

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What is anticoagulation management clinic referral?

Anticoagulation management clinic referral is a process where a healthcare provider refers a patient to a specialized clinic for the management of their anticoagulation therapy.

Who is required to file anticoagulation management clinic referral?

Healthcare providers such as physicians, nurse practitioners, and pharmacists are required to file anticoagulation management clinic referrals.

How to fill out anticoagulation management clinic referral?

To fill out an anticoagulation management clinic referral, healthcare providers must include the patient's medical history, current medications, and the reason for referral.

What is the purpose of anticoagulation management clinic referral?

The purpose of anticoagulation management clinic referral is to ensure that patients receiving anticoagulation therapy are monitored and managed by a specialized team to prevent complications.

What information must be reported on anticoagulation management clinic referral?

Information such as the patient's medical history, current medications, and reason for referral must be reported on an anticoagulation management clinic referral.