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Request for Podiatry Assessment (SelfReferral)
To be completed and submitted via Email attachment to LHNT.LCHSCAB@nhs.net or post to
Podiatry Administration, New land Clinic, 34 New land, Lincoln,
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How to fill out request for podiatry assessment
How to fill out request for podiatry assessment
01
Start by gathering all necessary information about the patient, including their personal details, medical history, and any specific issues they are experiencing with their feet.
02
Fill out the patient's personal details, such as their name, date of birth, contact information, and insurance details, if applicable.
03
Provide a detailed description of the patient's medical history, including any relevant injuries, surgeries, or pre-existing conditions that may affect their podiatry assessment.
04
Clearly outline the specific issues or symptoms the patient is experiencing with their feet, such as pain, swelling, deformities, or difficulties in walking or performing daily activities.
05
Include any supporting documentation or test results, such as X-rays, blood work, or previous medical reports, that may be relevant to the podiatry assessment.
06
Ensure that all sections of the request form are completed accurately and legibly to avoid any misunderstandings or delays in the assessment process.
07
Submit the completed request form to the appropriate healthcare provider or podiatry clinic, following their designated submission process.
08
Keep a copy of the completed request form for your records and for future reference if needed.
Who needs request for podiatry assessment?
01
Individuals who are experiencing any foot-related problems or have concerns about the condition of their feet may need to request a podiatry assessment.
02
This includes individuals with foot pain, difficulty in walking, foot deformities, injuries, or any other issues affecting the function or health of their feet.
03
People with chronic conditions like diabetes, arthritis, or circulation problems are also recommended to seek regular podiatry assessments to prevent complications.
04
Furthermore, individuals who require specialized foot care, such as athletes or those with occupation-related foot stress, may benefit from requesting a podiatry assessment.
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What is request for podiatry assessment?
Request for podiatry assessment is a form used to request an evaluation of a patient's foot or ankle condition by a podiatrist.
Who is required to file request for podiatry assessment?
The request for podiatry assessment can be filed by a physician or healthcare provider on behalf of the patient.
How to fill out request for podiatry assessment?
The request form typically requires information about the patient's medical history, symptoms, and any previous treatments.
What is the purpose of request for podiatry assessment?
The purpose of the request is to assess the patient's foot or ankle condition and determine the need for podiatric care.
What information must be reported on request for podiatry assessment?
The request form may require details such as the patient's name, age, contact information, insurance details, and referring physician.
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