Get the free 2008 Synagis referral form.doc - providers kaiserpermanente

Network news Produced by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., with the Mid-Atlantic Permanent Medical Group, P.C. Website: www.providers.kp.org/mas MARCH 2011 FOR NETWORK

How to fill out 2008 synagis referral formdoc

How to fill out 2008 Synagis Referral formdoc:

1. Start by opening the 2008 Synagis Referral formdoc on your computer or printing it out if you prefer a hard copy.
2. Fill out the patient's information, including their full name, date of birth, and contact information. Make sure to provide accurate and up-to-date details.
3. Indicate the patient's medical history related to respiratory syncytial virus (RSV) or any other relevant conditions. Include any previous hospitalizations or complications.
4. Provide details about the patient's healthcare provider, including their name, address, and contact information. This information is important for communication and coordination of care.
5. Specify the reason for referral, explaining why this patient requires Synagis treatment. Include any relevant diagnosis or risk factors that warrant the use of this medication.
6. Fill in the complete immunization history of the patient, including the dates and types of vaccines received. This information helps determine the patient's eligibility for Synagis.
7. If applicable, provide information about the patient's insurance coverage or any third-party payers involved. Include the policy number and any other necessary details.
8. Finally, ensure that all the required fields are completed and review the form for any errors or missing information. Sign and date the form to confirm its authenticity.

Who needs the 2008 Synagis referral formdoc:

1. Infants or young children at high risk of severe RSV infection may require the 2008 Synagis referral formdoc. These individuals may include premature infants, children with certain congenital heart or lung diseases, or those with compromised immune systems.
2. Healthcare professionals involved in the care and treatment of high-risk patients may also need the 2008 Synagis referral formdoc. This form is used to document the need for Synagis treatment and initiate the referral process.
3. Insurance companies or third-party payers may request the 2008 Synagis referral formdoc to verify the medical necessity of the prescribed medication. This ensures appropriate coverage and reimbursement for the treatment.

Note: It is important to consult with a healthcare provider familiar with the specific requirements and guidelines of the 2008 Synagis referral formdoc to ensure accurate completion.

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What is synagis referral formdoc?

Synagis referral formdoc is a document used to refer patients for Synagis administration to prevent respiratory syncytial virus (RSV) infection in high-risk infants.

Who is required to file synagis referral formdoc?

Healthcare providers, such as pediatricians or pulmonologists, are required to file the synagis referral formdoc for their high-risk infant patients.

How to fill out synagis referral formdoc?

To fill out the synagis referral formdoc, healthcare providers need to provide patient information, medical history, RSV risk factors, and justification for Synagis administration.

What is the purpose of synagis referral formdoc?

The purpose of the synagis referral formdoc is to facilitate the referral process for high-risk infants who require Synagis to prevent RSV infection.

What information must be reported on synagis referral formdoc?

The synagis referral formdoc must include patient demographics, medical history, RSV risk factors, and healthcare provider's justification for Synagis administration.