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Brigham and Womens Hospital Patient Slide free printable template

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PATIENT SLIDE CONSULTATION REQUEST FORM Results are released to the client (physician sending the case). By including this form with the slides, you acknowledge the patient is initiating the request
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How to fill out Brigham and Women's Hospital Patient Slide Consultation

01
Obtain the Brigham and Women's Hospital Patient Slide Consultation form.
02
Fill in patient details including name, date of birth, and medical record number.
03
Provide the referring physician's contact information.
04
Specify the clinical history relevant to the consultation.
05
List the specific questions or concerns regarding the pathology.
06
Include any prior pathology reports and relevant imaging studies.
07
Sign and date the form to confirm accuracy.
08
Submit the completed form along with the necessary slides to the designated address.

Who needs Brigham and Women's Hospital Patient Slide Consultation?

01
Patients who require a second opinion on pathology results.
02
Referring physicians who seek expert consultation on complex cases.
03
Individuals with atypical or rare conditions that need specialized assessment.
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Brigham and Women's Hospital Patient Slide Consultation is a service that allows pathologists to request a second opinion on slide samples from patients, enhancing diagnostic accuracy and patient care.
Pathologists or healthcare providers who require a secondary evaluation of a patient's pathology slides are required to file for the Brigham and Women's Hospital Patient Slide Consultation.
To fill out the Brigham and Women's Hospital Patient Slide Consultation, you must complete the consultation form with patient details, clinical history, and specific questions regarding the slide analysis.
The purpose of the Brigham and Women's Hospital Patient Slide Consultation is to provide expert opinions on pathology slides to improve diagnostic accuracy and ensure better treatment decisions for patients.
The information that must be reported includes patient's demographic details, clinical information, a description of the specimens, and the specific questions or concerns regarding the pathology findings.
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