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OUTPATIENT CONSULT REQUEST TO: Metabolism, Endocrinology & Diabetes/Podiatry (MEND) Domino's Farms (Lobby C, Suite 1300) 24 Frank Lloyd Wright Dr., PO Box 451 Ann Arbor, MI 481060451 Office: 7346475871
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How to fill out outpatient consult request to

01
To fill out an outpatient consult request, follow these steps:
02
Obtain the necessary forms from the outpatient department or download them from the hospital's website.
03
Fill out the patient's personal information, such as name, date of birth, address, and contact number.
04
Provide the patient's medical history, including any previous diagnoses, surgeries, or medications.
05
Specify the reason for the consultation and any specific questions or concerns for the consulting physician.
06
Attach relevant medical records, test results, and imaging studies that support the need for the consultation.
07
Sign and date the request form to certify its accuracy and completeness.
08
Submit the filled-out request form to the outpatient department either in person, by mail, or through an online submission portal.
09
Follow up with the outpatient department to confirm receipt of the request and to schedule the consultation appointment.
10
Attend the consultation appointment as scheduled and bring a copy of the filled-out request form and any supporting documents.

Who needs outpatient consult request to?

01
Anyone who requires a specialist's opinion or advice regarding their medical condition may need to fill out an outpatient consult request. This could include individuals who have been referred by their primary care physician, patients seeking a second opinion, individuals experiencing new or worsening symptoms, or those needing a follow-up consultation after a previous treatment or procedure.
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Outpatient consult request is a formal request made by a healthcare provider for a patient to receive a consultation from another healthcare provider outside of the hospital setting.
The healthcare provider responsible for the patient's care is typically required to file the outpatient consult request.
To fill out an outpatient consult request, the healthcare provider must include the patient's demographic information, relevant medical history, reason for consultation, and any specific questions or concerns.
The purpose of an outpatient consult request is to seek expert opinion or additional medical advice for the management of a patient's condition.
The outpatient consult request must include the patient's name, age, gender, medical record number, reason for consultation, referring provider's information, and any relevant medical history or test results.
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