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01.1731759. Retina Map Pads Layout 1 5/25/17 7:33 AM Page 1RetinaVitreous Associates Medical Group TO:, David S. Boyer, M.D., Inc., Thomas G. Chu, M.D., Ph.D., Inc., Humayun Abandon, M.D., M.S., F.R.C.P.,

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How to fill out referral form - retina

01

To fill out a referral form for retina, follow these steps:

02

Start by opening the referral form on your computer or printing it out if you prefer a physical copy.

03

Provide the patient's personal information such as name, date of birth, and contact details.

04

Include relevant medical history and any previous treatments undergone by the patient.

05

Describe the reason for the referral, specifying any symptoms or concerns that need further investigation.

06

Include any relevant test results or imaging studies that have been conducted.

07

Make sure to sign and date the form to validate the referral.

08

Submit the completed referral form to the appropriate healthcare provider or specialist.

09

Keep a copy of the referral form for your records.

Who needs referral form - retina?

01

The referral form for retina is typically needed by patients who require specialized care for retinal conditions or disorders.

02

This may include individuals experiencing vision problems, retinal detachment, macular degeneration, diabetic retinopathy, or other retina-related disorders.

03

It is also used by healthcare professionals, such as primary care physicians or optometrists, who want to refer their patients to an ophthalmologist or a retinal specialist for further evaluation and treatment.

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