Get the free LYMPHOMA REFERRAL FORM

DEPARTMENT OF MEDICAL ONCOLOGY HEMATOLOGY LYMPHOMA REFERRAL FORM FOR URGENT REFERRALS CONTACT PHYSICIAN DIRECTLY 610 University Avenue Toronto Ontario M5G 2M9 Phone 416 946 4575 Fax 416 946 2900 Date Sent All referrals for Lymphoma must be faxed to 416 946 2900 EXCEPT for Dr. OFFICE USE ONLY Date Received Physician Signature Appointment Date Time Interpreter Booked Y / N Date Clinic Comments March 2012 Ver 1. Michael Baker Fax 416 340 3464 PATIENT INFORMATION Last Name First Name Health Card...

How to fill out lymphoma referral form

How to fill out lymphoma referral form

1. Start by obtaining a copy of the lymphoma referral form from the appropriate source.
2. Read the instructions provided on the form carefully to understand the required information.
3. Ensure that you have the necessary patient details, such as full name, contact information, and date of birth.
4. Fill in the patient's medical history, including any previous diagnoses and treatments related to lymphoma.
5. Include information about the referring physician, their contact details, and their rationale for the referral.
6. Provide any relevant test results, imaging reports, or pathology samples along with the referral form.
7. Review the completed form for accuracy and completeness before submitting it to the appropriate recipient.
8. Submit the filled-out lymphoma referral form through the designated channels, as per the provided instructions.
9. Keep a copy of the referral form for your records.

Who needs lymphoma referral form?

1. Patients suspected of having lymphoma and requiring further evaluation and treatment.
2. Healthcare professionals who want to refer a patient with suspected lymphoma to a specialist.

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What is lymphoma referral form?

Lymphoma referral form is a document that is used to refer a patient to a specialist for further evaluation, diagnosis, and treatment of lymphoma.

Who is required to file lymphoma referral form?

Medical professionals such as doctors, oncologists, and hematologists are required to file lymphoma referral forms for patients suspected to have lymphoma.

How to fill out lymphoma referral form?

To fill out a lymphoma referral form, the medical professional must provide patient information, medical history, symptoms, and reason for referral to the specialist.

What is the purpose of lymphoma referral form?

The purpose of the lymphoma referral form is to ensure that patients with lymphoma receive timely and appropriate care from specialists who are experts in treating this type of cancer.

What information must be reported on lymphoma referral form?

Information such as patient demographics, medical history, symptoms, laboratory test results, imaging studies, and reason for referral must be reported on the lymphoma referral form.