UK HealthCare Developmental Behavioral Clinic Referral free printable template

Department of Pediatrics Division of Developmental Behavioral Pediatrics University of Kentucky Clinic 740 South Limestone Lexington, KY 405360284Dear Pediatric Care Provider, The Kentucky Children's

How to fill out developmental behavioral pediatrics referral

How to fill out UK HealthCare Developmental Behavioral Clinic Referral Form

1. Obtain the UK HealthCare Developmental Behavioral Clinic Referral Form from the clinic's website or reception.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Provide the referring physician's information, including name, practice name, and contact details.
4. Describe the reason for the referral, including specific concerns or diagnoses.
5. Include any relevant medical history or previous assessments associated with the patient.
6. Attach any supporting documents or test results if available.
7. Review the form for completeness and accuracy.
8. Submit the form via fax, email, or in person as instructed.

Who needs UK HealthCare Developmental Behavioral Clinic Referral Form?

1. Children or adolescents with developmental or behavioral concerns.
2. Parents or guardians seeking evaluation or treatment for their child's developmental issues.
3. Healthcare providers who need to refer a patient for specialized developmental or behavioral assessment.

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What is UK HealthCare Developmental Behavioral Clinic Referral Form?

The UK HealthCare Developmental Behavioral Clinic Referral Form is a document used to refer patients to the developmental and behavioral health services offered at UK HealthCare.

Who is required to file UK HealthCare Developmental Behavioral Clinic Referral Form?

Typically, healthcare providers, such as pediatricians, psychologists, or other medical professionals, are required to file the UK HealthCare Developmental Behavioral Clinic Referral Form on behalf of the patient.

How to fill out UK HealthCare Developmental Behavioral Clinic Referral Form?

To fill out the UK HealthCare Developmental Behavioral Clinic Referral Form, providers must include patient details, the reason for referral, relevant medical history, and any specific developmental or behavioral concerns.

What is the purpose of UK HealthCare Developmental Behavioral Clinic Referral Form?

The purpose of the UK HealthCare Developmental Behavioral Clinic Referral Form is to initiate the evaluation process for patients needing specialized developmental or behavioral health services.

What information must be reported on UK HealthCare Developmental Behavioral Clinic Referral Form?

The information that must be reported on the UK HealthCare Developmental Behavioral Clinic Referral Form includes patient demographics, presenting issues, medical history, previous assessments, and any specific recommendations by the referring provider.