Get the free Cardiology REFERRAL REQUEST - Wilmington Health

Wilmington Health Division of Cardiology 1202 Medical Center Drive Wilmington, NC 28401www.wilmingtonhealth.com Fax: (910) 7633980 & (910) 8152914 Referral Fax: (910) 3411900 Phone: (910) 3413301

How to fill out cardiology referral request

How to fill out cardiology referral request

1. Start by obtaining the necessary referral form from the cardiology department or your healthcare provider.
2. Fill out your personal information accurately, including your name, contact number, address, and date of birth.
3. Provide details about your primary healthcare provider, including their name, contact information, and specialty.
4. Specify the reason for the cardiology referral request, including any symptoms or medical conditions you have been experiencing.
5. If you have undergone any relevant medical tests or procedures, include the results or attach copies of the reports.
6. Indicate any medications you are currently taking, including the dosage and frequency.
7. Include any relevant medical history or previous cardiology consultations.
8. If applicable, provide information about your insurance coverage or any financial assistance programs you are enrolled in.
9. Review the completed referral request form for accuracy and completeness before submitting it to the cardiology department or your healthcare provider.
10. Follow any additional instructions provided by the cardiology department or your healthcare provider regarding the submission of the referral request.

Who needs cardiology referral request?

1. A cardiology referral request is needed by individuals who require specialized cardiac care or evaluation from a cardiologist.
2. This includes individuals who have been experiencing cardiovascular symptoms such as chest pain, shortness of breath, palpitations, or fatigue.
3. Patients with known cardiac conditions or risk factors may also require a cardiology referral request for ongoing management and monitoring.
4. Healthcare providers may determine the need for a cardiology referral based on the individual's medical history, symptoms, or results of initial assessments and tests.

For pdfFiller’s FAQs

What is cardiology referral request?

A cardiology referral request is a formal request made by a healthcare provider to refer a patient to a cardiology specialist for further evaluation and treatment.

Who is required to file cardiology referral request?

Any healthcare provider such as a primary care physician or specialist who believes a patient may benefit from cardiology evaluation and care is required to file a cardiology referral request.

How to fill out cardiology referral request?

To fill out a cardiology referral request, healthcare providers must include the patient's medical history, current symptoms, relevant test results, and reason for the referral.

What is the purpose of cardiology referral request?

The purpose of a cardiology referral request is to ensure that patients receive timely and appropriate care from cardiology specialists to address their cardiovascular health needs.

What information must be reported on cardiology referral request?

Information such as patient demographics, medical history, current symptoms, relevant test results, and reason for referral must be reported on a cardiology referral request.

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