Get the free BENIGN HEMATOLOGY REFERRAL FORM

DEPARTMENT OF MEDICAL ONCOLOGY HEMATOLOGY BENIGN HEMATOLOGY REFERRAL FORM FOR URGENT REFERRALS CONTACT PHYSICIAN DIRECTLY 200 Elizabeth Street Toronto Ontario M5G 2C4 Phone 416 340 4205 Fax 416 340 3590 Date Sent All referrals for Benign Hematology must be faxed to 416 340 3590 EXCEPT for Dr. OFFICE USE ONLY Date Received Physician Signature Appointment Date Time Interpreter Booked Y / N Date Clinic Comments March 2012 Ver 1. Richard Ward Fax 416 790 8066 PATIENT INFORMATION Last Name First...

How to fill out benign hematology referral form

How to fill out benign hematology referral form

1. Gather all necessary patient information such as name, date of birth, and contact details.
2. Fill out the referring physician information including name, contact information, and clinic/hospital name.
3. Provide a detailed patient medical history, including any previous diagnoses or treatments.
4. Specify the reason for referral and provide relevant symptoms or concerns.
5. Include any relevant laboratory or test results pertaining to the patient's hematology condition.
6. Indicate the preferred date and time for the appointment, if applicable.
7. Sign and date the referral form to validate the information.
8. Make sure to submit the filled-out form to the appropriate recipient or department.

Who needs benign hematology referral form?

1. Patients exhibiting symptoms of a potential benign hematology condition.
2. Physicians who need to refer their patients to a specialist for further evaluation and management of benign hematology disorders.
3. Any healthcare professional involved in the diagnosis and treatment of benign hematology conditions.

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What is benign hematology referral form?

Benign hematology referral form is a document used to refer patients with non-malignant blood disorders to a specialist for further evaluation and treatment.

Who is required to file benign hematology referral form?

Healthcare providers such as primary care physicians, hematologists, or oncologists are required to file the benign hematology referral form for their patients.

How to fill out benign hematology referral form?

Benign hematology referral form can be filled out by providing patient information, medical history, reason for referral, and any relevant test results.

What is the purpose of benign hematology referral form?

The purpose of benign hematology referral form is to ensure that patients with non-malignant blood disorders receive appropriate care from a specialist.

What information must be reported on benign hematology referral form?

Information such as patient demographics, medical history, current symptoms, and any relevant test results must be reported on benign hematology referral form.