Get the free DHEC Provider Fax Referral Form

General 1. DHEC provider must follow the protocol in the DHEC Tobacco Cessation Intervention Policy 2As R before referring a client to the Quitline. DHEC 1042 07/2014 Instructions for Completing the South Carolina Tobacco Quitline DHEC Form 1042 is used to refer a DHEC client who smokes or uses other tobacco products to the South Carolina Tobacco Quitline via a fax referral system. The following steps must be followed prior to sending a fax referral to the Quitline. SOUTH CAROLINA TOBACCO...

How to fill out dhec provider fax referral

How to fill out dhec provider fax referral

1. Step 1: Get the dhec provider fax referral form from the DHEC website or your healthcare provider.
2. Step 2: Read the instructions on the form carefully.
3. Step 3: Gather all the necessary information to fill out the form, such as patient details, referring physician information, and medical history.
4. Step 4: Start filling out the form by entering the patient's personal information, including name, address, and contact details.
5. Step 5: Provide the details of the referring physician, including their name, contact information, and medical license number.
6. Step 6: Fill in the patient's medical history and the reason for the referral. Be as specific as possible.
7. Step 7: Double-check all the information you have entered to ensure accuracy.
8. Step 8: Submit the completed dhec provider fax referral form to the appropriate recipient as instructed.
9. Step 9: Keep a copy of the submitted form for your records.

Who needs dhec provider fax referral?

1. DHEC provider fax referral is required for individuals who need specialized medical care or diagnostic tests that can only be accessed through a referral from their healthcare provider.
2. Typically, patients who need to see a specialist, undergo certain medical procedures, or receive specialized treatments will require a dhec provider fax referral.
3. Healthcare providers, such as primary care physicians or specialists, are the ones responsible for determining if their patients require a referral and issuing the dhec provider fax referral accordingly.
4. In some cases, insurance companies may also require a dhec provider fax referral in order to provide coverage for certain medical services or to ensure that they are medically necessary.

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What is dhec provider fax referral?

DHEC provider fax referral is a form used to refer patients to the Department of Health and Environmental Control for specific services or follow-up.

Who is required to file dhec provider fax referral?

Healthcare providers, clinics, and hospitals are required to file DHEC provider fax referral for their patients.

How to fill out dhec provider fax referral?

To fill out DHEC provider fax referral, healthcare providers need to provide patient information, reason for referral, and any relevant medical history.

What is the purpose of dhec provider fax referral?

The purpose of DHEC provider fax referral is to ensure that patients receive appropriate care and follow-up services from the Department of Health and Environmental Control.

What information must be reported on dhec provider fax referral?

Patient demographics, reason for referral, relevant medical history, and healthcare provider information must be reported on DHEC provider fax referral.