Get the free Hypertension Referral Form - ASTHO

Hypertension Referral Form Patient Name: DOB: Provider Recommending Referral: Date: First BP Reading: REASON FOR REFERRAL Elevated BP at today's appointment. (140+/90+) Previously diagnosed hypertension

How to fill out hypertension referral form

How to fill out hypertension referral form

1. To fill out a hypertension referral form, follow these steps:
2. Start by providing your personal information, such as your name, address, and contact details.
3. Indicate your medical history, including any previous diagnoses related to hypertension.
4. Specify the reason for the referral, whether it is for a general consultation or a specific concern.
5. If you have been monitoring your blood pressure at home, include the recorded readings and dates.
6. Mention any medications or treatments you are currently undergoing for hypertension.
7. Provide information about your primary care physician or healthcare provider.
8. Finally, sign and date the referral form before submitting it to the appropriate healthcare professional.

Who needs hypertension referral form?

1. The hypertension referral form is typically needed by individuals who require specialized care or consultation for hypertension.
2. This may include individuals who have been diagnosed with hypertension by their primary care physician and need to see a specialist for further evaluation or treatment.
3. It can also be necessary for individuals who experience symptoms related to hypertension, such as persistent high blood pressure, chest pain, or significant changes in blood pressure readings.
4. Overall, anyone with concerns or a need for specialized care regarding hypertension may require a hypertension referral form.

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What is hypertension referral form?

Hypertension referral form is a document used to refer patients with high blood pressure to specialized healthcare providers for further evaluation and treatment.

Who is required to file hypertension referral form?

Healthcare providers, such as primary care physicians, nurses, and specialists, are required to file hypertension referral form for patients with high blood pressure.

How to fill out hypertension referral form?

Hypertension referral form should be filled out with the patient's personal information, medical history, blood pressure readings, and reason for referral to a specialist.

What is the purpose of hypertension referral form?

The purpose of hypertension referral form is to ensure that patients with high blood pressure receive appropriate care and follow-up from healthcare professionals.

What information must be reported on hypertension referral form?

Information such as patient's name, date of birth, blood pressure readings, medical history, current medications, and reason for referral must be reported on hypertension referral form.