Get the free PDSP FAX REFERRAL FORM 9-22-05.doc. S. 11, PSST Regulations - hawaiiaap

PRESCHOOL DEVELOPMENTAL SCREENING PROGRAM Hawaii State Department of Health 1700 Lanka Avenue, Room 210 Honolulu, Hawaii 96817 Phone (808) 832-5675 Fax (808) 832-5680 DSP FAX REFERRAL FORM* Request

How to fill out pdsp fax referral form

How to fill out a PDSP fax referral form:

1. Start by downloading the PDSP fax referral form from the official website or obtaining a physical copy from the relevant department.
2. Begin filling out the patient's personal information section, including their full name, date of birth, address, contact number, and any other requested details.
3. Provide the patient's primary healthcare provider information, such as their name, contact details, and clinic address.
4. Indicate the reason for the referral, whether it's for a specific medical condition, specialist consultation, diagnostic procedure, or any other relevant purpose.
5. Specify the preferred date and time for the appointment, if applicable. If there is no specific preference, you can leave this section blank.
6. If the referral is medically urgent, ensure to mark it as such and provide any additional details or instructions on the urgency.
7. Next, include any relevant medical history or diagnostic reports that may assist the specialist or healthcare provider in understanding the patient's condition better.
8. If there are any specific documents that need to be submitted with the referral, mention them in the appropriate section and ensure that they are attached or sent along with the form.
9. Review the filled information for accuracy and completeness. Double-check all the details provided to minimize errors or omissions.
10. Once you are confident that all the sections are appropriately filled, sign and date the referral form.
11. Finally, either fax the completed referral form to the designated fax number provided by the healthcare provider or follow any alternative submission instructions mentioned on the form.

Who needs a PDSP fax referral form:

1. Patients who require specialized medical care or consultations beyond the expertise of their primary healthcare provider.
2. Individuals who have been advised to seek a specific diagnostic procedure or medical evaluation by their primary healthcare provider.
3. Anyone who needs a referral to a specialist or another healthcare provider as per the requirements of their healthcare plan or insurance coverage.

Remember, the specific circumstances and requirements for needing a PDSP fax referral form may vary, so it is always advisable to consult with your primary healthcare provider or refer to your healthcare plan guidelines to ensure compliance.

For pdfFiller’s FAQs

What is pdsp fax referral form?

The PDSP fax referral form is a document used to refer patients to the PDSP program via fax.

Who is required to file pdsp fax referral form?

Healthcare providers who wish to refer patients to the PDSP program are required to file the form.

How to fill out pdsp fax referral form?

To fill out the PDSP fax referral form, healthcare providers need to provide patient information, medical history, and reason for referral.

What is the purpose of pdsp fax referral form?

The purpose of the PDSP fax referral form is to facilitate the referral process for patients who need specialized care.

What information must be reported on pdsp fax referral form?

The PDSP fax referral form must include patient details, medical history, reason for referral, and healthcare provider information.

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