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NHS North West London Direct Optometrist Fax Referral Pathway For Wet AMD and Medical Retina Assessment (v2.3 01/10/2015) Central London Hammersmith & Fulham CCGHillingdon CCG West London Please fax
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How to fill out fax referral form for
How to fill out fax referral form for
01
Gather all the necessary information such as patient's name, contact information, and healthcare provider's name.
02
Obtain a copy of the fax referral form from your healthcare provider.
03
Fill out the patient information section with accurate details.
04
Provide a brief description of the patient's medical condition or reason for referral.
05
Include any supporting documents or test results, if required.
06
Ensure that the form is signed and dated by the referring healthcare provider.
07
Double-check the completed form for any errors or missing information.
08
Dial the fax number provided by the recipient and transmit the form.
09
Keep a copy of the sent fax referral form for your records.
Who needs fax referral form for?
01
Patients who require a referral to see a specialist or receive specific medical services.
02
Healthcare providers who need to refer their patients to other specialists or facilities for further evaluation or treatment.
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