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University of North Carolina Hospitals Chapel Hill, North Carolina 27517 CARDIAC REHABILITATION PHYSICIAN REFERRAL FORM MIM# PILOT Section must be completed accurately to process referral Patient
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How to fill out cardiac rehabilitation physician referral
How to fill out a cardiac rehabilitation physician referral:
01
Obtain the necessary referral form from your healthcare provider or cardiac rehabilitation center.
02
Fill in your personal information, including your name, date of birth, address, and contact information.
03
Provide your medical history, including any relevant diagnoses, procedures, or surgeries you have undergone related to your heart health.
04
Indicate the reason for your referral to cardiac rehabilitation, whether it is for post-heart attack recovery, heart surgery rehabilitation, or managing a chronic heart condition.
05
Include any relevant information regarding your current medications, including dosage and frequency.
06
Specify any allergies or adverse reactions you may have to medications or treatments.
07
If applicable, provide information about your current exercise routine, including the type of exercises you are performing and any limitations or modifications you require.
08
If you have any specific goals or concerns regarding your cardiac rehabilitation, such as improving fitness levels or managing symptoms, make sure to mention them.
09
Ensure that your referral is signed and dated by your healthcare provider.
Who needs a cardiac rehabilitation physician referral?
01
Individuals who have recently experienced a heart attack and are seeking to recover and improve their heart health.
02
Patients who have undergone heart surgery, such as coronary bypass or valve replacement, and require postoperative rehabilitation.
03
People with chronic heart conditions, such as congestive heart failure or arrhythmias, who need comprehensive management and support.
04
Those at high risk for developing heart disease, such as individuals with diabetes or a family history of heart conditions, who would benefit from preventive measures and lifestyle modifications.
Remember, the need for a cardiac rehabilitation physician referral may vary depending on your healthcare system and specific circumstances. It is essential to consult with your healthcare provider or contact the cardiac rehabilitation center for accurate and up-to-date information.
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What is cardiac rehabilitation physician referral?
Cardiac rehabilitation physician referral is a process where a physician recommends a patient to participate in a structured program to help recover from a heart-related issue.
Who is required to file cardiac rehabilitation physician referral?
The physician overseeing the patient's care is typically required to file the cardiac rehabilitation physician referral.
How to fill out cardiac rehabilitation physician referral?
The referral can be filled out by the physician and should include relevant medical information about the patient.
What is the purpose of cardiac rehabilitation physician referral?
The purpose of the referral is to ensure that patients receive proper support and guidance in their recovery from a heart-related issue.
What information must be reported on cardiac rehabilitation physician referral?
The referral should include the patient's medical history, current condition, and any specific recommendations for their rehabilitation program.
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