Get the free Injury Medicine Referral - Carolina Bone and Joint, PA
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Injury Medicine Referral Form Fax 7042893076 Or via email Perez boners.org1. Patient Information: Patient Name: Male / Revalidate of Injury : Patient Mailing Address: City, State, Zip: Phone: DOB:
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How to fill out injury medicine referral
How to fill out injury medicine referral
01
Obtain an injury medicine referral form from your healthcare provider or download it from their website.
02
Fill out your personal information, including your name, address, phone number, and date of birth.
03
Provide details about your injury, including when and how it occurred, any symptoms you are experiencing, and any treatments you have already received.
04
Indicate the healthcare provider or specialist that you are being referred to for injury medicine.
05
Sign and date the referral form, ensuring that all required fields are completed.
06
Make a copy of the completed referral form for your records.
07
Submit the referral form to the healthcare provider or specialist as instructed, either by mail, fax, or in person.
Who needs injury medicine referral?
01
Individuals who have sustained an injury and require specialized medical evaluation and treatment can benefit from an injury medicine referral. This may include individuals with sports injuries, work-related injuries, or those involved in accidents.
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