Get the free PULMONARY REHAB PROGRAM REFERRAL FORM

Client Health Record # Client Surname Given Name PULMONARY REHAB PROGRAM REFERRAL FORM PHONE: (204) 8312181 FAX: (204) 9408633 PAIN Deer Lodge Center DATE OF REFERRAL: D M Client Contact Information:

How to fill out pulmonary rehab program referral

Who needs pulmonary rehab program referral?

1. Patients with chronic lung diseases such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or asthma may require a pulmonary rehab program referral.
2. Individuals who have recently undergone lung surgery or a lung transplant may also benefit from pulmonary rehabilitation.
3. Patients with significant breathing difficulties, exercise limitations, or reduced quality of life due to a lung condition may be advised to seek a referral for pulmonary rehab.

How to fill out pulmonary rehab program referral:

1. Contact your primary care physician or specialist: Schedule an appointment with your healthcare provider who can assess your lung condition and determine if a pulmonary rehab program is appropriate for you. They will guide you through the referral process.
2. Explain your symptoms and goals: During your appointment, communicate your symptoms, how they impact your daily life, and what goals you hope to achieve through pulmonary rehabilitation. This information will help your healthcare provider understand your needs better.
3. Provide necessary medical history: Your healthcare provider will need your medical history, including any prior lung-related diagnoses, treatments, or surgeries. Be prepared to share this information accurately.
4. Undergo necessary tests and assessments: Your healthcare provider may request additional tests or assessments to gather more information about your lung function. These may include pulmonary function tests, exercise tolerance tests, or imaging studies. Ensure you follow through with these tests to aid in your referral process.
5. Obtain a referral form: Your healthcare provider will provide you with a referral form specific to the pulmonary rehab program they recommend. This form may contain sections for your personal details, medical history, and specific reasons for the referral.
6. Complete the referral form accurately: Fill out the referral form completely and accurately, providing detailed information where required. Double-check the information before submitting it to avoid any errors or delays.
7. Follow any additional instructions: Your healthcare provider may provide specific instructions or information about where to send the referral form. Follow these instructions carefully to ensure the referral reaches the appropriate healthcare professional or facility.
8. Follow up and confirm receipt: After submitting the referral form, follow up with your healthcare provider or the pulmonary rehab program to confirm they have received the referral. This step ensures that your referral is being processed and you can expect to hear back regarding your enrollment in the program.

Remember, the process of filling out a pulmonary rehab program referral may vary depending on your healthcare provider and location. It's essential to stay in communication with your healthcare team throughout the process and ask any questions or seek clarification when needed.

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What is pulmonary rehab program referral?

Pulmonary rehabilitation program referral is a medical referral made by a healthcare provider for patients with chronic lung conditions to participate in a comprehensive program to improve their lung function and overall quality of life.

Who is required to file pulmonary rehab program referral?

Healthcare providers such as pulmonologists, respiratory therapists, or primary care physicians are typically responsible for filing the pulmonary rehab program referral.

How to fill out pulmonary rehab program referral?

The referral should include the patient's medical history, current lung function status, and any other relevant information to determine their eligibility and help create a personalized treatment plan.

What is the purpose of pulmonary rehab program referral?

The purpose of the referral is to provide patients with access to specialized care, education, and services designed to improve their lung function, exercise capacity, and overall well-being.

What information must be reported on pulmonary rehab program referral?

The referral should include the patient's demographic information, medical history, recent pulmonary function test results, and any other relevant clinical information.