Get the free Referral Form Obstetrical Ultrasound - Dartmouth-Hitchcock

Department of Radiology Please fax request to: Referral Form Obstetrical Ultrasound Fax: (603) 653-6141 Today s Date: Appointment Date: Appointment Time: Patient Name: MAN: DOB: Mailing address: Home

How to fill out referral form obstetrical ultrasound

How to fill out a referral form for an obstetrical ultrasound:

1. Start by obtaining the referral form from the appropriate medical facility or provider. This may be a specific form provided by the facility or a general referral form that can be used for various medical services.
2. Begin filling out the form with your personal information. This typically includes your full name, date of birth, contact information, and any relevant medical history. It is important to provide accurate and up-to-date information to ensure proper communication and recordkeeping.
3. Next, provide the details of the obstetrical ultrasound referral. This includes the reason for the referral, any specific concerns or questions, and any additional information that may be important for the healthcare provider to know. Be clear and concise in your description to help guide the provider in their assessment.
4. If you were referred by a specific healthcare professional, such as your primary care physician or obstetrician, include their name, contact information, and any additional details required by the form. This helps ensure proper communication and coordination of care between healthcare providers.
5. Review the completed form for accuracy and completeness. Double-check all the information you have provided to make sure there are no errors or omissions. This step is crucial to avoid any potential delays or misunderstandings in scheduling or receiving the obstetrical ultrasound.
6. Finally, sign and date the referral form as required. Some forms may also require a signature from a healthcare provider or staff member. Follow any additional instructions provided on the form to ensure compliance and proper processing.

Who needs a referral form for an obstetrical ultrasound?

1. Pregnant women seeking prenatal care: Obstetrical ultrasounds are a routine part of prenatal care to monitor fetal development and assess the health of both the mother and the baby. In many cases, pregnant women may need a referral from their primary care physician or obstetrician to schedule an obstetrical ultrasound at a specific facility or with a certain healthcare provider.
2. Healthcare providers: Obstetrical ultrasounds may be requested by healthcare providers who are monitoring a pregnancy or managing a patient's prenatal care. These providers may need to fill out a referral form to arrange for the ultrasound to be performed by a radiology or ultrasound specialist.
3. Women with specific medical conditions or concerns: Some women may require obstetrical ultrasounds for specific medical reasons, such as high-risk pregnancies, suspected fetal abnormalities, or complications during pregnancy. In these cases, a referral form may be necessary to ensure the appropriate ultrasounds are performed and interpreted by specialized healthcare professionals.

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What is referral form obstetrical ultrasound?

Referral form obstetrical ultrasound is a document used to refer a pregnant individual for an ultrasound to monitor the health and development of the fetus.

Who is required to file referral form obstetrical ultrasound?

Healthcare providers, such as obstetricians or midwives, are required to file referral form obstetrical ultrasound for their pregnant patients.

How to fill out referral form obstetrical ultrasound?

Referral form obstetrical ultrasound should be filled out by providing the patient's personal information, medical history, reason for referral, and any specific instructions or concerns.

What is the purpose of referral form obstetrical ultrasound?

The purpose of referral form obstetrical ultrasound is to ensure pregnant individuals receive necessary monitoring and care during pregnancy.

What information must be reported on referral form obstetrical ultrasound?

Information such as patient's name, age, gestational age, medical history, reason for referral, and any previous ultrasound results must be reported on referral form obstetrical ultrasound.