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COMMUNITY PHARMACY REFERRAL FORM
THIS PATIENT HAS PRESENTED AT A COMMUNITY PHARMACYSITUATION
A community pharmacist referral of a patient to GP Practice Team/Dentist/Optician
Patient Name:
Address:DOB:CHI:BACKGROUND
This
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To fill out this patient has presented, follow these steps:
02
Gather all the necessary information about the patient, including personal details, medical history, current symptoms, and any existing medical reports.
03
Start by filling out the personal details section, which typically includes the patient's name, age, gender, contact information, and insurance details.
04
Move on to the medical history section and provide a detailed account of the patient's past illnesses, surgeries, allergies, and any chronic conditions they have.
05
Proceed to document the patient's current symptoms, noting the onset, duration, severity, and any associated factors.
06
If there are any existing medical reports or diagnostic test results, attach them to the patient's record.
07
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08
Submit the filled-out patient has presented form to the appropriate healthcare provider or facility.
Who needs this patient has presented?
01
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What is this patient has presented?
The patient has presented with symptoms of fever and cough.
Who is required to file this patient has presented?
The attending physician is required to file this patient has presented.
How to fill out this patient has presented?
The patient has presented form should be filled out with the patient's symptoms, medical history, and any relevant test results.
What is the purpose of this patient has presented?
The purpose of this patient has presented form is to document the patient's symptoms and medical history for further treatment and diagnosis.
What information must be reported on this patient has presented?
The patient's name, date of birth, symptoms, medical history, and any relevant test results must be reported on this patient has presented form.
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