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60 Lynda Cove, Ste. C Jackson, TN 38305 Phone 7316687593 Fax 7316607512 healthconnectamerica.com REFERRAL FORM Please fax to: (731× 6607512 Referring Agency Contact Information: If Parent×Guardian
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How to fill out referral bformb please fax
How to fill out referral form please fax:
01
Begin by gathering all necessary information for the referral, including the patient's name, contact information, and any relevant medical history.
02
Make sure to include the referring physician's name, contact information, and any specific instructions or reasons for the referral.
03
Fill out the date and time of the referral accurately.
04
Include any supporting documentation or medical records that may be required for the referral.
05
Double-check all entered information for accuracy and completeness before finalizing the form.
06
Fax the completed referral form to the appropriate recipient, ensuring that the fax number is correct and legible.
Who needs referral form please fax:
01
Patients who have been recommended to seek specialist care by their primary care physician.
02
Healthcare providers or physicians who need to refer their patients to other medical specialists or facilities.
03
Insurance companies or authorization departments that require a referral to approve certain medical procedures or services.
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