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OFFICE USE ONLY: IMCC # Referral received date / Time: 200 North Park Street Kalamazoo, MI 490073731 Phone: 269.382.2500 / Fax: 269.373.7431 www.wmcc.orgSCHEDULING REFERRAL FORM Please check ALL the
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How to fill out scheduling - referral form
How to fill out scheduling - referral form
01
Begin by gathering all the necessary information needed to complete the scheduling-referral form.
02
Fill in the patient's personal information, such as name, contact details, and address.
03
Provide details about the referring physician or healthcare provider, including their name, contact information, and any relevant identification numbers.
04
Specify the reason for the referral and provide a brief summary of the patient's medical history, if applicable.
05
Indicate the preferred date and time for the scheduled appointment, if known.
06
Mention any specific requirements or additional information that may be relevant for the referral.
07
Double-check all the details filled in the form for accuracy and completeness.
08
Submit the form to the designated receiving party or authority, as per the instructions provided.
Who needs scheduling - referral form?
01
Scheduling-referral forms are typically needed by patients who require specialized medical care or services that can only be provided by a different healthcare provider.
02
They may also be required for individuals who are being referred to specific facilities or specialists for diagnostic tests, consultations, or treatments.
03
These forms help streamline the referral process by ensuring that all relevant information is accurately captured and communicated between healthcare providers.
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