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PATIENT REFERRAL REQUEST TO: DURHAM GASTROENTEROLOGY CONSULTANTS, PA SCOTT R. BRAZER, MD AND DAVID A. TENDER, MD 249 East NC54, SUITE 200 DURHAM, NC 27713 PHONE: 9198068322 FAX: 9194330409Date: Physician:

What is PATIENT REFERRAL REQUEST Form?

The PATIENT REFERRAL REQUEST is a fillable form in MS Word extension required to be submitted to the relevant address to provide some info. It needs to be completed and signed, which can be done manually in hard copy, or with the help of a particular software such as PDFfiller. This tool allows to complete any PDF or Word document directly in your browser, customize it depending on your needs and put a legally-binding e-signature. Right away after completion, the user can easily send the PATIENT REFERRAL REQUEST to the appropriate receiver, or multiple ones via email or fax. The editable template is printable as well because of PDFfiller feature and options offered for printing out adjustment. In both digital and in hard copy, your form will have got neat and professional appearance. It's also possible to turn it into a template for further use, there's no need to create a new document from the beginning. Just amend the ready template.

PATIENT REFERRAL REQUEST template instructions

Once you are ready to begin completing the PATIENT REFERRAL REQUEST .doc form, you have to make certain that all required information is prepared. This very part is highly significant, so far as mistakes may result in unwanted consequences. It's actually annoying and time-consuming to re-submit the whole template, not speaking about penalties came from missed due dates. Handling the digits requires a lot of attention. At first glimpse, there’s nothing challenging about this task. Nevertheless, there's nothing to make an error. Professionals recommend to keep all data and get it separately in a document. Once you've got a template so far, you can just export this information from the document. Anyway, it's up to you how far can you go to provide accurate and legit info. Doublecheck the information in your PATIENT REFERRAL REQUEST form while completing all required fields. In case of any mistake, it can be promptly fixed via PDFfiller editor, so that all deadlines are met.

PATIENT REFERRAL REQUEST word template: frequently asked questions

1. I have some personal word forms to fill out and sign. Is there any chance some other person would have got access to them?

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• Private cloud storage where all files are kept protected with sophisticated encryption. This way you can be sure nobody would have got access to your personal information but yourself. Disclosure of the information is strictly prohibited all the way.
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2. Have never heard of electronic signatures. Are they similar comparing to physical ones?

Yes, and it's totally legal. After ESIGN Act concluded in 2000, an electronic signature is considered legal, just like physical one is. You are able to complete a file and sign it, and to official institutions it will be the same as if you signed a hard copy with pen, old-fashioned. While submitting PATIENT REFERRAL REQUEST form, you have a right to approve it with a digital solution. Make sure that it fits to all legal requirements as PDFfiller does.

3. I have a spreadsheet with some of required information all set. Can I use it with this form somehow?

In PDFfiller, there is a feature called Fill in Bulk. It helps to make an export of data from document to the online template. The big yes about this feature is, you can excerpt information from the Excel spreadsheet and move it to the document that you’re generating with PDFfiller.

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What is patient referral request?

Patient referral request is a formal request made by a healthcare provider to refer a patient to another healthcare provider or specialist for further evaluation or treatment.

Who is required to file patient referral request?

The primary healthcare provider or physician overseeing the patient's care is typically required to file the patient referral request.

How to fill out patient referral request?

The patient referral request form must be completed with the patient's personal information, reason for referral, relevant medical history, and any other pertinent details.

What is the purpose of patient referral request?

The purpose of a patient referral request is to ensure that the patient receives appropriate and specialized care from a healthcare provider who is better equipped to address their specific medical needs.

What information must be reported on patient referral request?

The patient's name, date of birth, medical history, reason for referral, contact information, and any relevant test results or diagnostic reports must be reported on the patient referral request.