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REFERRAL AND INITIAL INFORMATION RECORD SSD Case Numbers Date referral received Is the parent×carer aware of the referral? S Yes s No Referral s Child×Young Persons name, address and responsible

How to fill out referral and initial information

How to fill out a referral and initial information:

1. Start by gathering all the necessary documents and information needed for the referral and initial information form. This may include personal details, contact information, medical history, and any relevant reports or test results.
2. Begin by providing your full name, date of birth, and address in the designated fields. Make sure to double-check for any spelling errors or typos.
3. Next, include your contact details such as phone number and email address. This is crucial for the healthcare provider to reach you for any follow-up or additional information if needed.
4. Proceed to provide your medical history, including any previous or existing medical conditions, surgeries, allergies, and medications you are currently taking. Be as accurate and detailed as possible to ensure effective and safe medical care.
5. If applicable, mention any recent diagnostic test results or reports that may be relevant to your current health condition. Include the date and location of the tests as well.
6. It is also important to mention your primary care physician's name and contact information, as well as any other healthcare professionals involved in your care.
7. Finally, take the time to read through the form once completed to make sure all the information provided is accurate and up-to-date. If any sections are unclear or require additional explanation, do not hesitate to ask for assistance from the healthcare provider's staff.

Who needs referral and initial information?

Referral and initial information forms are typically required by healthcare providers when a patient is seeking specialized or specialized care beyond the scope of their primary care physician. This may include referrals for specialist consultations, diagnostic tests, surgeries, or other medical procedures. It is essential for the healthcare provider to have accurate and detailed information about the patient's medical history, current health status, and any relevant test results to provide appropriate and effective care.

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