Get the free Referral Form 2014-03-28 - Legacy Health - legacyhealth

Legacy Health Anticoagulation Clinic Referral Form (very 3/14) Legacy Meridian Park Anticoagulation Clinic 6475 SW Bowland Road, Suite F Tualatin, Oregon 97062 Phone: (503) 692-7794 Fax: (503) 692-7795

How to fill out referral form 2014-03-28

How to fill out referral form 2014-03-28?

1. Start by gathering all the necessary information: Before filling out the referral form, make sure you have all the required information at hand. This may include details about the person being referred, their contact information, reason for referral, and any supporting documentation.
2. Begin with personal details: Start by filling out the personal details section of the referral form. This typically includes the individual's full name, date of birth, address, phone number, and email address. Ensure that all information is accurate and up-to-date.
3. Provide relevant medical information: If the referral form pertains to a medical referral, you will likely be asked to provide medical information about the individual. This may include their medical history, any existing conditions, medications, allergies, and previous treatments received. It is important to be thorough and provide as much detail as possible.
4. Specify the reason for referral: In this section, you will need to explain the reason for the referral. Clearly state the primary concern or condition that requires specialist attention or further evaluation. Be concise and provide any relevant background information that may assist the referral recipient in understanding the situation.
5. Attach supporting documentation if required: Some referral forms may require you to attach supporting documents such as medical test results, imaging reports, or other relevant records. Ensure that you have gathered all the necessary documents and securely attach them to the referral form before submitting.
6. Complete additional sections as applicable: Depending on the nature of the referral, there may be additional sections to fill out. This could include areas for specific clinical information or any additional requests or notes you wish to include. Fill out these sections as instructed, providing accurate and relevant information.

Who needs referral form 2014-03-28?

1. Patients seeking specialized care: The referral form 2014-03-28 is typically needed by patients who require specialized care or evaluation beyond the scope of their primary healthcare provider. This form allows the referring provider to communicate important information and highlights the need for a referral to a specific specialist or facility.
2. Healthcare professionals: Referral forms are also used by healthcare professionals, such as primary care physicians, to refer their patients to specialists or other healthcare providers. These professionals may need to fill out the referral form 2014-03-28 when determining that a patient requires specialized care.
3. Insurance companies or healthcare administrators: Referral forms may also be required by insurance companies or healthcare administrators to ensure that the referral for specialized care is properly documented and authorized. These entities may need the referral form 2014-03-28 to process and approve the referral and associated healthcare services.

For pdfFiller’s FAQs

What is referral form 03-28?

Referral form 03-28 is a document used to refer a case or individual to a specific department or agency for further action or evaluation.

Who is required to file referral form 03-28?

Individuals or entities who have relevant information or concerns about a particular case or individual are required to file referral form 03-28.

How to fill out referral form 03-28?

To fill out referral form 03-28, one must provide detailed information about the case or individual being referred, including any supporting documentation or evidence.

What is the purpose of referral form 03-28?

The purpose of referral form 03-28 is to ensure that relevant information is properly documented and forwarded to the appropriate department or agency for further review and action.

What information must be reported on referral form 03-28?

Information such as the nature of the case or concern, names of individuals involved, relevant dates, and any supporting evidence must be reported on referral form 03-28.

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