Get the free shriners referral form

D. Chief of Orthopedics David Greenhalgh M. D. Chief of Burns Loren Davidson M. D. Director Spinal Cord Injury Shinjiro Hirose M. Hospital Leadership Treatment Specialties Margaret Bryan Chief Executive Officer Michelle James M. Urgent Referral The referring physician should contact the physician-on-call by calling General Pediatric Orthopedics Upper Limb Program Limb Deficiency Program Complex Spine Program Sports Programs Neuromuscular Programs Burns Urgent Burn Care burns of any size...

How to fill out shriners referral form

How to fill out shriners referral form:

1. Obtain the shriners referral form from their official website or by contacting their representative.
2. Fill in your personal information accurately, including your full name, address, phone number, and email.
3. Provide details about the patient for whom you are seeking a referral, including their name, age, gender, and medical condition.
4. Fill in any relevant medical history of the patient, including past treatments, surgeries, and medications.
5. Include information about the primary healthcare provider or specialist who has been treating the patient.
6. Provide a brief summary of the patient's condition, including symptoms, limitations, and the need for specialized care.
7. Attach any supporting documents that are requested, such as medical reports, diagnostic images, or referral letters from other healthcare professionals.
8. Sign and date the form to verify the accuracy of the information provided.
9. Submit the completed shriners referral form through the designated channels, either by mail, email, or through an online portal if available.

Who needs shriners referral form:

1. Individuals seeking specialized medical care for orthopedic conditions, burns, spinal cord injuries, or cleft lip and palate may need a shriners referral form.
2. Patients who require the unique expertise and resources available at shriners hospitals for children would need a referral form.
3. Healthcare providers or specialists who are aware of the patient's condition but recommend specialized care at shriners hospitals may also need to complete a referral form.

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What is shriners referral form?

The Shriners referral form is a document used to initiate the process of referring a patient to Shriners Hospitals for Children for specialized medical care.

Who is required to file shriners referral form?

Healthcare professionals, such as doctors or medical practitioners, are typically required to file the Shriners referral form to ensure that patients are correctly referred for treatment.

How to fill out shriners referral form?

To fill out the Shriners referral form, healthcare providers must provide necessary information such as patient details, medical history, and the specific reasons for referral, ensuring all sections of the form are completed accurately.

What is the purpose of shriners referral form?

The purpose of the Shriners referral form is to facilitate the connection between patients requiring specialized care and Shriners Hospitals, ensuring appropriate medical evaluation and treatment.

What information must be reported on shriners referral form?

The information that must be reported on the Shriners referral form includes the patient's personal details, contact information, medical history, insurance information, and specific medical concerns or needs.