Get the free Faculty Practice Patient Referral Form02-14-2014 in WORD FINAL1.docx

ECU SCHOOL OF DENTAL MEDICINE Patients: Please call in advance to schedule your appointment. Thank you for being flexible as we work you in for care. Led yard E. Ross Hall 1851 MacGregor Downs Road,

How to fill out faculty practice patient referral

How to fill out faculty practice patient referral

1. To fill out faculty practice patient referral, follow these steps:
2. Obtain a referral form from the faculty practice office or download it from their website.
3. Fill out the patient information section, including their name, contact information, and date of birth.
4. Provide details about the reason for the referral, including the specific condition or symptoms that require specialist attention.
5. Indicate the preferred faculty or specialist that the patient should be referred to, if applicable.
6. Include any relevant medical history or previous treatments that may be helpful for the specialist to know.
7. Complete the referring provider information section, including your name, contact information, and any necessary signatures or credentials.
8. Ensure all required fields are filled out accurately and legibly.
9. Submit the completed referral form to the faculty practice office or follow their specified submission process.
10. Keep a copy of the referral form for your records.
11. Follow up with the patient to confirm the referral has been received and schedule any necessary appointments.

Who needs faculty practice patient referral?

1. Faculty practice patient referral may be needed by:
2. - Primary care physicians who want to refer their patients to a specialist within the faculty practice.
3. - Patients who require specialized care or evaluation by a faculty member or specialist affiliated with the practice.
4. - Other healthcare providers seeking consultation or collaboration with faculty specialists.

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What is faculty practice patient referral?

Faculty practice patient referral is the process of referring a patient to a specific faculty or department within a medical practice for specialized care or treatment.

Who is required to file faculty practice patient referral?

Faculty members or healthcare providers who wish to refer a patient to another faculty or department within the practice.

How to fill out faculty practice patient referral?

The referral form must be completed with the patient's information, reason for referral, and any relevant medical history.

What is the purpose of faculty practice patient referral?

The purpose of faculty practice patient referral is to ensure that patients receive the appropriate care and treatment from specialized faculty within the medical practice.

What information must be reported on faculty practice patient referral?

Patient's information, reason for referral, medical history, and any other relevant details.