OH The MetroHealth System External Physician Referral Form 2018 free printable template

The MetroHealth System 2500 MetroHealth Drive Cleveland, OH 44109 2169573222External Physician Referral Form Phone 2169573222 Fax 2167782700 PLEASE PRINT ALL INFORMATION CLEARLY Thank you for referring

How to fill out OH form MetroHealth System External Physician

How to fill out OH The MetroHealth System External Physician Referral Form

1. Obtain the OH The MetroHealth System External Physician Referral Form from the official website or your local MetroHealth office.
2. Fill in the patient's information including their full name, date of birth, and contact details.
3. Provide the referring physician's details including name, contact information, and practice address.
4. Include the patient's insurance information, if applicable.
5. Check the boxes for the specific services required or the reasons for referral.
6. Sign and date the form to confirm that the information is accurate to the best of your knowledge.
7. Submit the completed form either electronically or via fax according to the instructions provided.

Who needs OH The MetroHealth System External Physician Referral Form?

1. Any healthcare provider who wishes to refer a patient to OH The MetroHealth System for specialized services.
2. Patients seeking to have a referral for treatment or consultation at MetroHealth.
3. Insurance companies that require a referral for coverage of specific services at MetroHealth.

People Also Ask about

How do you refer a patient to a specialist?

Situation: Explain the patient's condition and symptoms. Include relevant administrative information — such as the patient's name, referring physician, and medical unit. Background: Describe the patient's medical history. Include previous diagnoses, medication info, and treatment dates.

How to do a referral for a patient?

Situation: Explain the patient's condition and symptoms. Include relevant administrative information — such as the patient's name, referring physician, and medical unit. Background: Describe the patient's medical history. Include previous diagnoses, medication info, and treatment dates.

How do I get referred to the Cleveland Clinic?

The Referring Physician Hotline can be reached 24 hours a day, 7 days a week, by calling 855. REFER. 123 (855.733. 3712).

What is the process of a patient being referred to a specialist?

The referring doctor or health professional will provide the specialist with as much information about your condition as they think is needed. Once the specialist has seen you, they will in turn send details of your recommended treatment back to the doctor or health professional who referred you.

How do you refer to Cleveland Clinic?

Contact the Referring Physician Hotline, 24 hours a day, 7 days a week, at 855. REFER. 123 (855.733. 3712).

Can I refer myself to Cleveland Clinic?

Cleveland Clinic does not require a referral, however your insurance company might require one to provide coverage for your visit or procedure.

What is the fax number for Cleveland Clinic referrals?

How do I refer a patient to Cleveland Clinic? To refer a patient to a Cleveland Clinic location in Ohio, please print and fill out our referral form and fax to 216.448. 9738 (Attention: Referring Physician Hotline). You can also refer a patient by phone using our Referring Physician Hotline at 855.

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What is OH The MetroHealth System External Physician Referral Form?

The OH The MetroHealth System External Physician Referral Form is a document used by external physicians to refer patients to MetroHealth for specialized medical services or consultations.

Who is required to file OH The MetroHealth System External Physician Referral Form?

External physicians who wish to refer their patients to MetroHealth for further evaluation or treatment are required to file the OH The MetroHealth System External Physician Referral Form.

How to fill out OH The MetroHealth System External Physician Referral Form?

To fill out the OH The MetroHealth System External Physician Referral Form, the referring physician should provide patient information, the reason for the referral, relevant medical history, and any specific requests for care.

What is the purpose of OH The MetroHealth System External Physician Referral Form?

The purpose of the OH The MetroHealth System External Physician Referral Form is to facilitate the referral process for patients needing specialized care, ensuring that all necessary information is communicated effectively to MetroHealth.

What information must be reported on OH The MetroHealth System External Physician Referral Form?

The information that must be reported on the OH The MetroHealth System External Physician Referral Form includes the patient's demographic details, the reason for referral, the referring physician's information, relevant medical history, and any additional notes or requests.