Get the free Infant Referral

Referral to Maternal Infant Health Program Midland County Health Department 220 West Ellsworth Street Midland, MI 486405194 Telephone: 989 8326686 Fax 989 8326628 Infants Full Name Date of Birth Parents

How to fill out infant referral

How to fill out infant referral

1. To fill out an infant referral, follow these steps:
2. Gather all necessary information about the infant, such as their name, date of birth, and parent contact details.
3. Identify the reason for the referral. Are there any specific concerns or medical conditions that need to be addressed?
4. Obtain a referral form from the appropriate healthcare provider or agency.
5. Fill out the referral form accurately and legibly. Provide all required information, including the infant's medical history, current symptoms, and any relevant test or examination results.
6. If applicable, attach any supporting documents or medical reports that may aid in the referral process.
7. Double-check the completed form for any errors or missing information.
8. Submit the filled-out referral form to the designated recipient, such as a pediatrician, specialist, or healthcare facility.
9. Follow up with the recipient to ensure the referral is received and acknowledged.
10. Keep a copy of the referral form and any related documents for your records.

Who needs infant referral?

1. Infant referral is typically needed for parents or caregivers who have concerns about their infant's health or development.
2. Some situations that may warrant an infant referral include:
3. - Suspected developmental delays
4. - Medical conditions requiring specialized care
5. - Behavioral or psychological concerns
6. - Evaluation for genetic disorders
7. - Postnatal complications or abnormalities
8. - Need for early intervention services
9. - Assessment for hearing or vision impairment
10. - Referral from a primary care physician or pediatrician.

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What is infant referral?

Infant referral is the process of referring a newborn or young child to the appropriate services or agencies for support and assistance.

Who is required to file infant referral?

Parents, guardians, healthcare providers, or social workers are typically required to file infant referral.

How to fill out infant referral?

Infant referral forms can usually be filled out online, by phone, or in person at the designated agency or organization.

What is the purpose of infant referral?

The purpose of infant referral is to ensure that newborns and young children receive the necessary support and services for their well-being and development.

What information must be reported on infant referral?

Information such as the child's name, date of birth, parent/guardian contact details, and reason for referral are typically required on an infant referral.