UC Davis Health Referral intake form 2017-2025 free printable template

Referring a patient Thank you for choosing UC Davis Health and for referring your patient to us. We appreciate the opportunity to partner with you in your patients care. To begin the referral process,

How to fill out UC Davis Health Referral intake form

How to fill out UC Davis Health Referral intake form

1. Obtain the UC Davis Health Referral intake form from the UC Davis Health website or your healthcare provider.
2. Begin by entering your personal information, including full name, date of birth, and contact details.
3. Fill in your insurance information, including the insurance provider's name, policy number, and group number if applicable.
4. Provide information about your primary care physician and their contact details.
5. Indicate the reason for the referral and any relevant medical history or notes that may assist the specialist.
6. Sign and date the form to confirm that the information provided is accurate.
7. Submit the completed form via the specified method (mail, fax, or online submission) provided by UC Davis Health.

Who needs UC Davis Health Referral intake form?

1. Patients seeking specialized medical care or treatment at UC Davis Health.
2. Individuals who require a referral from their primary care physician to see a specialist.
3. Those covered by insurance plans that necessitate a referral for specialist appointments.

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What is UC Davis Health Referral intake form?

The UC Davis Health Referral intake form is a document used to initiate and manage patient referrals within the UC Davis Health system.

Who is required to file UC Davis Health Referral intake form?

Healthcare providers, including primary care physicians and specialists, are required to file the UC Davis Health Referral intake form for their patients who need additional medical services.

How to fill out UC Davis Health Referral intake form?

To fill out the UC Davis Health Referral intake form, gather necessary patient information, including demographics, medical history, and the specific referral details, and follow the provided instructions on the form.

What is the purpose of UC Davis Health Referral intake form?

The purpose of the UC Davis Health Referral intake form is to streamline the referral process, ensuring that patients receive timely and appropriate care from specialists.

What information must be reported on UC Davis Health Referral intake form?

The information that must be reported on the UC Davis Health Referral intake form includes the patient's personal information, insurance details, referring provider information, and the reason for the referral.