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GENETICS REFERRAL FORM Email: genetics@austin.org.auTelephone: (03) 9496 3027Fax: (03) 9496 4385 REFERRAL SOURCE / DR STAMP: Dr Address: Phone: Fax: Provider No: Email: Signature:DATE OF REFERRAL:CLIENT
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How to fill out genetics referral form

01
To fill out a genetics referral form, follow these steps:
02
Start by providing your personal information such as your name, date of birth, contact information, and address.
03
Next, include details about your medical history, including any known genetic conditions or family history of genetic disorders.
04
Specify the reason for the referral, whether it is for genetic counseling, testing, or evaluation.
05
If you have been referred by a healthcare provider, include their name, contact information, and any relevant medical records or test results.
06
Ensure you sign and date the form before submitting it to the appropriate genetics department or clinic.
07
It is recommended to include any additional information or questions you may have regarding your genetic concerns or conditions.
08
Make sure to keep a copy of the completed referral form for your records.
09
Remember, it is essential to provide accurate and detailed information on the genetics referral form to ensure proper evaluation and care.

Who needs genetics referral form?

01
The genetics referral form is typically required for individuals who may benefit from genetic counseling, testing, or evaluation. This includes but is not limited to:
02
- Individuals with a personal or family history of genetic disorders
03
- Pregnant women seeking prenatal screening or testing
04
- Patients with symptoms or suspected genetic conditions
05
- Individuals with a family history of inherited cancers
06
- Couples planning to start a family and are concerned about potential genetic risks
07
- Those seeking guidance or information related to carrier screening for genetic conditions
08
It is advisable to consult with a healthcare provider or genetic counselor to determine if a genetics referral form is necessary in your specific case.

What is GENETICS REFERRAL - Austin Form?

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A genetics referral form is a document used to refer individuals to a genetics specialist or clinic for evaluation, diagnosis, and management of genetic conditions.
Typically, healthcare providers such as primary care physicians or specialists who suspect a genetic condition in a patient are required to file a genetics referral form.
To fill out a genetics referral form, one must provide patient information, reason for referral, relevant medical history, and any family history of genetic conditions.
The purpose of the genetics referral form is to facilitate the patient's access to specialized genetic services by providing necessary information to the genetics specialists.
Information such as patient demographics, medical history, family history of genetic conditions, and specific reasons for the referral must be reported on the genetics referral form.
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