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Ultrasound Referral Date: / / 201 Dr. Teresa Jacobson 1955 Kirchner Road, Kelowna, B.C. V1Y 4N7 2508623435 Fax: 2508623814 Pages: / Referring Clinic: ; Veterinarian: Referring Clinic Phone # ; Email
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How to fill out ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet
How to fill out ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet:
01
Start by entering the date of the referral at the top of the form. This ensures that the referral is properly dated and recorded.
02
Next, fill in the name of the referring veterinarian or clinic in the designated section. This helps identify where the referral is coming from.
03
Provide the contact information of the referring veterinarian or clinic. This includes their phone number, address, and email, which will be used for communication purposes.
04
Indicate the patient's information on the form. This includes the patient's name, species, breed, age, sex, and any other relevant details.
05
Describe the reason for the ultrasound referral. This section should include a brief explanation of the specific health concern or condition that necessitates the ultrasound examination.
06
Specify any additional instructions or requests for the ultrasound procedure. This is the area where any specific areas of interest or specific diagnostic tests can be mentioned.
07
Provide any relevant medical history or current medications the patient is taking. This helps the receiving clinic to have a comprehensive understanding of the patient's health status.
08
Finally, sign and date the referral form. This ensures that the referral is authorized by the referring veterinarian or clinic.
Who needs ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet:
01
Veterinarians or clinics referring a patient for an ultrasound examination.
02
Veterinary specialists or diagnostic imaging centers receiving referrals for ultrasound services.
03
Patients or pet owners who need to provide a completed referral form to the receiving clinic in order to schedule an ultrasound appointment.
Note: The specific individual or entity that needs the ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet may vary depending on the specific veterinary practice or clinic and their policies and procedures.
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What is ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet?
Ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet is a document used for referring patients for ultrasound procedures at Jacobson Veterinary Clinic.
Who is required to file ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet?
Veterinarians or other medical professionals referring patients for ultrasound procedures at Jacobson Veterinary Clinic are required to file this form.
How to fill out ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet?
The form must be filled out with all relevant patient information, reason for referral, and any necessary medical history. It should then be submitted to Jacobson Veterinary Clinic.
What is the purpose of ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet?
The purpose of this form is to provide necessary information for referring patients for ultrasound procedures at Jacobson Veterinary Clinic.
What information must be reported on ultrasound-referral-form-to-oformr-clinics1doc - jacobsonvet?
Patient's name, contact information, reason for referral, medical history, and any relevant test results must be reported on the form.
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