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The Swallowing Clinic Referral Form The Clinic provides a clinical swallowing assessment by a SpeechLanguage Pathologist. A Fiber optic Endoscopic Evaluation of Swallowing may be required to complete

How to fill out the swallowing clinic referral

How to fill out the swallowing clinic referral

1. To fill out the swallowing clinic referral, follow the below steps:
2. Download the referral form from the clinic's website.
3. Fill in the patient's personal information such as name, date of birth, and contact details.
4. Provide details about the patient's medical history, including any relevant diagnoses or conditions.
5. Describe the swallowing difficulties or symptoms experienced by the patient.
6. Include any relevant test results or medical reports that support the referral.
7. Specify the preferred appointment date and time, if applicable.
8. Provide your contact information as the referring healthcare professional.
9. Review the completed referral form for accuracy and completeness.
10. Submit the referral form through the specified method, such as fax or email.
11. Follow up with the swallowing clinic to ensure they received the referral.
12. Note: The exact steps may vary depending on the specific clinic and their referral process. It is recommended to refer to any provided instructions or guidelines when filling out the referral form.

Who needs the swallowing clinic referral?

1. Individuals who are experiencing swallowing difficulties or have been recommended by a healthcare professional may need a swallowing clinic referral.
2. This referral is typically required for patients who exhibit symptoms such as frequent choking, difficulty swallowing food or liquids, persistent coughing during or after eating/drinking, unexplained weight loss, or aspiration pneumonia.
3. The swallowing clinic referral allows the patient to receive specialized evaluation, diagnosis, and treatment for their swallowing concerns.

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What is the swallowing clinic referral?

The swallowing clinic referral is a document used to refer a patient to a specialized clinic for evaluation and treatment of swallowing disorders.

Who is required to file the swallowing clinic referral?

The referring healthcare provider, such as a physician or speech-language pathologist, is required to file the swallowing clinic referral.

How to fill out the swallowing clinic referral?

The swallowing clinic referral is typically filled out with the patient's demographic information, medical history, and reason for referral.

What is the purpose of the swallowing clinic referral?

The purpose of the swallowing clinic referral is to facilitate communication between healthcare providers and ensure that patients receive appropriate evaluation and treatment for their swallowing disorders.

What information must be reported on the swallowing clinic referral?

The swallowing clinic referral should include the patient's name, date of birth, medical history related to swallowing issues, current medications, and any relevant test results.