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COLORECTAL SURGERY NASCENT HEALTH A Service of Nascent Health Physician Group Michael D. Honker, M.D. BoardCertified Surgeon REFERRING PHYSICIAN NPI ADDRESS CITY STATE ZIP CODE PHONE FAX CONTACT PERSON
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How to fill out colo referral formdoc
How to fill out colo referral formdoc
01
Open the colo referral formdoc.
02
Read the instructions carefully before filling out the form.
03
Provide your personal information such as name, date of birth, and contact details.
04
Specify the reason for the referral and provide any relevant medical history or test results.
05
Provide the name and contact information of the referring healthcare provider.
06
Sign and date the form to confirm your consent.
07
Review the completed form for accuracy and completeness before submitting it.
Who needs colo referral formdoc?
01
Anyone who requires a referral for a colonoscopy (colorectal cancer screening) may need to fill out the colo referral formdoc. This includes individuals with a family history of colorectal cancer or other risk factors, as well as those who are due for routine screening based on age guidelines or medical recommendations.
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What is colo referral formdoc?
Colo referral formdoc is a document used for referring a patient to a colorectal specialist.
Who is required to file colo referral formdoc?
Primary care physicians are typically required to file colo referral formdoc for their patients who need to see a specialist.
How to fill out colo referral formdoc?
Colo referral formdoc can be filled out by providing the patient's information, reason for referral, and any relevant medical history.
What is the purpose of colo referral formdoc?
The purpose of colo referral formdoc is to ensure that patients receive the necessary care from a specialist for their colorectal health issues.
What information must be reported on colo referral formdoc?
The information reported on colo referral formdoc should include patient's name, contact information, reason for referral, and any relevant medical history.
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