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Auth #: Western Oregon Advanced Health, LLC. P.O. Box 1096, Coos Bay, OR 97420 Voice: 541-269-7400 800-264-0014 Fax: 541-269-7147 TTY: 877-769-7400 Physician Authorization Request For questions call:
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How to fill out woah physician auth-ref form05202014update
How to fill out the woah physician auth-ref form05202014update:
01
Begin by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and the information that needs to be filled out.
02
Start with the first section of the form, usually labeled as "Patient Information." Enter the required details such as the patient's name, date of birth, address, and contact information. Double-check the accuracy of the information before moving on to the next section.
03
Proceed to the "Physician Information" section. Fill in the details of the referring physician, including their name, address, phone number, and medical license number if applicable.
04
In the "Referral Information" section, provide the reason for the referral and any specific instructions or requirements that need to be followed.
05
If there are any accompanying documents or reports that need to be attached to the form, make sure to do so securely. Follow any instructions provided regarding documents or additional information.
06
Review the completed form for any errors or missing information. Ensure that all sections have been properly filled out.
07
After ensuring the accuracy of the information, sign and date the form as required. If there is a designated area for the physician's signature, make sure to complete it.
08
Keep a copy of the completed form for your records before submitting it to the relevant recipient.
Who needs the woah physician auth-ref form05202014update?
01
Medical professionals or healthcare providers who are referring a patient for further examination, consultation, or treatment.
02
Patients who have been advised to seek additional medical attention or specialized care by their primary healthcare provider or physician.
03
Healthcare facilities or organizations that require a referral form for proper documentation and coordination of patient care.
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What is woah physician auth-ref form05202014update?
The woah physician auth-ref form05202014update is a form used for authorizing referrals to medical specialists.
Who is required to file woah physician auth-ref form05202014update?
Medical providers and facilities are required to file the woah physician auth-ref form05202014update when referring a patient to a specialist.
How to fill out woah physician auth-ref form05202014update?
To fill out the woah physician auth-ref form05202014update, providers need to input patient information, reason for referral, specialist details, and a signature.
What is the purpose of woah physician auth-ref form05202014update?
The purpose of the woah physician auth-ref form05202014update is to ensure proper authorization and documentation of patient referrals to specialists.
What information must be reported on woah physician auth-ref form05202014update?
The woah physician auth-ref form05202014update must include patient demographics, reason for referral, specialist information, and provider signature.
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