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Referral for Structural Heart Services At the University of Washington Medical Center PATIENT INFORMATION Last NameFirst NameDOBPatient Phone Number(s)Primary InsuranceMember REFERRING INFORMATION Referring
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Open the provider-resource-rhc-form-tavr.docx file in Microsoft Word.
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Read the instructions and guidelines for filling out the form.
03
Start by entering the date in the designated field.
04
Enter the name and contact information of the healthcare provider or organization.
05
Provide the patient's personal details such as name, address, date of birth, and contact information.
06
Fill in the patient's medical history, including previous heart procedures and surgeries.
07
Enter the required information about the patient's current symptoms and condition.
08
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Who needs provider-resource-rhc-form-tavrdocx?

01
The provider-resource-rhc-form-tavr.docx is needed by healthcare providers or organizations who are involved in transcatheter aortic valve replacement (TAVR) procedures. This form helps collect necessary information about the patient's medical history, current condition, and other relevant details for TAVR evaluation and documentation.
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Provider-resource-rhc-form-tavrdocx is a form used for reporting information related to Transcatheter Aortic Valve Replacement (TAVR) procedures.
Healthcare providers who perform or are involved in TAVR procedures are required to file provider-resource-rhc-form-tavrdocx.
Provider-resource-rhc-form-tavrdocx can be filled out electronically or manually, following the instructions provided on the form.
The purpose of provider-resource-rhc-form-tavrdocx is to collect data on TAVR procedures for research, quality improvement, and regulatory purposes.
Provider-resource-rhc-form-tavrdocx must include information such as patient demographics, procedure details, post-procedure outcomes, and any complications.
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