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JENNY GARBER, DVM DONALD J. BROWN, DVM, PhD DIPLOMAT ACHIM CARDIOLOGY (802)4772877 Veterinarian use ONLY VermontVeterinaryCardiology.com CARDIOLOGYCONSULTATIONREQUESTFORM PleaseFAXto8666270388 priortoyourclientsappointment.
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How to fill out cardiology consultation request form
How to fill out cardiology consultation request form
01
First, gather all the necessary information about the patient including their personal details and medical history.
02
Start by filling out the patient's name, date of birth, and contact information in the designated fields on the form.
03
Next, provide details about the referring physician or healthcare provider who is requesting the cardiology consultation.
04
Specify the reason for the consultation request, including any relevant symptoms or medical conditions that require evaluation.
05
In the appropriate section, list any medications the patient is currently taking, along with their dosages.
06
If the patient has any known allergies, make sure to indicate them on the form.
07
Include any relevant test results or medical imaging reports that have been performed prior to the consultation request.
08
If applicable, provide information about the patient's insurance coverage and policy details.
09
Finally, sign and date the form to complete the cardiology consultation request.
Who needs cardiology consultation request form?
01
Patients who are experiencing cardiovascular symptoms such as chest pain, shortness of breath, or palpitations may need a cardiology consultation request form.
02
Individuals who have been referred by their primary care physician for further evaluation of a potential heart condition would also require this form.
03
Patients with a history of heart disease or risk factors such as high blood pressure, diabetes, or smoking may need to fill out a cardiology consultation request form.
04
Individuals who have had abnormal findings on previous cardiac tests or screenings would be required to complete this form for a specialist consultation.
05
Healthcare providers who suspect a cardiac abnormality or require a cardiologist's expertise for a patient's care may also utilize this consultation request form.
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