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Podiatry Referral Form www. carepointrx. com Fax 855-237-9113 Toll Free 855-237-9112 911B Plum Grove Road Schaumburg IL 60173 PATIENT INFORMATION Rx for in-office use only Patient Name DOB Phone Address City State Zip Applicable Diagnosis Codes/Descriptions PLEASE FAX COPY OF FACE SHEET IF AVAILABLE PRESCRIPTION INFORMATION ANTIFUNGAL Ala-Quin Cream Clotrimazole 1 cream Ciclodan cream Econazole 1 cream Ecoza Foam Kerydin Solution Luzu Cream MetroGel / Cream Miconazole 2 cream Naftin...

How to fill out podiatry referral form

How to fill out podiatry referral form?

1. Begin by gathering all necessary information. This may include the patient's name, contact information, date of birth, and any relevant medical history.
2. Clearly indicate the reason for the referral. Describe the specific foot or ankle condition or concern that requires the expertise of a podiatrist.
3. Provide any relevant supporting documents. This may include medical records, X-rays, MRI results, or any other relevant diagnostic imaging. These documents will help the podiatrist better understand the patient's condition and plan appropriate treatment.
4. Include any relevant information regarding the patient's insurance coverage. This may require the referral form to include the patient's insurance information, policy number, and any necessary authorization codes.
5. Ensure the referring healthcare provider's information is complete and accurate. This includes their name, contact information, and any necessary credentials or identification numbers.

Who needs podiatry referral form?

1. Patients who are experiencing foot or ankle-related concerns or conditions that require specialized care from a podiatrist may need a podiatry referral form. Examples of such conditions may include foot and ankle injuries, chronic pain, deformities, or complications related to diabetes.
2. Typically, a podiatry referral form is needed when the patient's primary care physician or another healthcare provider determines that the expertise of a podiatrist is necessary for diagnosis, treatment, or management of the patient's foot or ankle condition.
3. Insurance companies may also require a podiatry referral form as part of their authorization process. This helps ensure that the treatment provided by the podiatrist is covered by the patient's insurance plan.

Overall, the podiatry referral form serves as a means to facilitate appropriate and timely access to specialized foot and ankle care for patients who require it.

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What is podiatry referral form?

A podiatry referral form is a document used by healthcare providers to refer patients to a podiatrist for specialized foot and ankle care.

Who is required to file podiatry referral form?

Typically, healthcare providers such as general practitioners or specialists who identify foot or ankle issues in their patients are required to file a podiatry referral form.

How to fill out podiatry referral form?

To fill out a podiatry referral form, the referring provider needs to include patient information, reason for referral, medical history, and any relevant diagnostic findings.

What is the purpose of podiatry referral form?

The purpose of the podiatry referral form is to ensure that patients receive the appropriate foot and ankle treatment from a qualified podiatrist, facilitating continuity of care.

What information must be reported on podiatry referral form?

The information that must be reported on a podiatry referral form includes patient demographics, medical history, specific concerns about foot and ankle health, and any previous treatment received.