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Diagnosis/ICD10 (Required):630 East State Highway 114 South lake, TX 76092 Phone (817) 3298910 Fax (817) 3298911BUN/Creatine (for contrast only):Allergies: Name (required): Male Female DOB:Address:City:State:Home

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How to fill out medx eves referral pad

01

To fill out the MedX Eves referral pad, follow these steps:

02

Start by filling in the patient's personal information, including their name, address, and contact details.

03

Next, provide the patient's medical history, including any known allergies or previous treatments.

04

Indicate the reason for the referral, including the specific symptoms or condition that requires the attention of MedX Eves.

05

Specify any additional information or concerns that should be addressed by MedX Eves.

06

Finally, sign and date the referral pad to complete the process.

Who needs medx eves referral pad?

01

MedX Eves referral pad is needed by healthcare professionals or doctors who want to refer a patient to MedX Eves for specialized medical attention or treatment.

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