Get the free WHN Referral Form - Westside Head and Neck

Referral Request Thank you for choosing Westside Head & Neck. We look forward to partnering with you in your patients care. Please fax form to: (310) 2044474 or call us at (310) 2044111 Date: #pages:

How to fill out whn referral form

Points on how to fill out a WHN referral form:

1. Start by gathering all the necessary information: Before filling out the referral form, make sure you have all the required information such as the patient's name, date of birth, contact details, and any relevant medical history.
2. Check the referral criteria: Familiarize yourself with the specific criteria for referring patients to the WHN. Ensure that the patient meets the eligibility requirements before proceeding to fill out the form.
3. Provide the referring healthcare professional's details: Include your name, designation, contact information, and any relevant identification numbers as the referring healthcare professional.
4. Specify the patient's information: Fill in the patient's full name, date of birth, address, contact number, and any other requested personal information accurately.
5. Describe the reason for referral: Clearly articulate the reasons for referring the patient to the WHN. Provide a detailed summary of the patient's condition, current symptoms, medical history, and any relevant diagnostic test results or imaging reports.
6. Attach supporting documents: If necessary, attach any supporting documents that might assist the WHN in evaluating the patient's case. This may include medical records, test results, referral letters from other healthcare professionals, or any other relevant documentation.
7. Review and finalize the form: Take a moment to review the completed referral form thoroughly. Double-check the accuracy of the information provided and ensure that all necessary sections have been filled out correctly.

Who needs a WHN referral form?

1. Patients seeking specialized care: Individuals who require specialized medical attention beyond the scope of their primary care provider may need a WHN referral form. This may include conditions that necessitate expert consultation, advanced diagnostic procedures, or complex treatment options.
2. Healthcare professionals referring patients: Healthcare professionals who believe their patients would benefit from the services provided by the WHN may need to fill out a referral form. This includes general practitioners, specialists, surgeons, or any other healthcare provider involved in the patient's care.
3. Institutions facilitating referrals: Healthcare institutions, such as hospitals, clinics, or healthcare networks, may require their staff to fill out WHN referral forms when referring patients to the network. This ensures a streamlined process and effective communication between healthcare providers involved in a patient's care.

For pdfFiller’s FAQs

What is whn referral form?

The WHN referral form is a document used to refer an individual to the Workplace Harassment Network.

Who is required to file whn referral form?

Anyone who witnesses or experiences workplace harassment is required to file a WHN referral form.

How to fill out whn referral form?

The WHN referral form can be filled out online or in person at the designated office. It requires information about the incident of harassment and the individuals involved.

What is the purpose of whn referral form?

The purpose of the WHN referral form is to report incidents of workplace harassment and ensure they are properly documented and addressed.

What information must be reported on whn referral form?

Information such as the date, time, location, and description of the harassment incident, as well as the names of the individuals involved, must be reported on the WHN referral form.

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