Get the free KHCC Patient referral form. March 2014 - kidneyspecialist

KIDNEY AND HYPERTENSION CARE CENTER, PA 1213 Hermann Dr., Suite 460, Houston, Texas 77004 ? Tel: (713) 520-6222 ? Fax: (713) 520-6223 Monday Friday: 8:00 am to 5:00 pm, For after hours support dial

How to fill out khcc patient referral form

How to fill out the KHCC patient referral form:

1. Start by providing your personal information such as your full name, date of birth, address, and contact details. This will help the KHCC staff to easily identify and contact you.
2. Next, provide information about your referring physician or healthcare provider. Include their name, contact information, and any additional details that may be required, such as their specialty or clinic name. This will help KHCC understand who is referring you and coordinate your care if needed.
3. Specify the reason for the referral. Clearly state the medical condition or concern that requires attention from KHCC. Include any relevant information about your symptoms, previous diagnoses, or ongoing treatments. This will assist the KHCC team in understanding your medical needs and providing appropriate care.
4. If you have any preferences or specific requirements regarding your appointment at KHCC, mention them in the appropriate section. This may include any language preferences, accessibility needs, or other considerations that can help facilitate your visit to KHCC.
5. Finally, sign and date the referral form. Make sure to review all the information provided on the form for accuracy and completeness before submitting it. Double-check if you have attached any supporting documents, such as medical reports or test results, if required.

Who needs KHCC patient referral form:

1. Individuals who have been diagnosed with a medical condition that requires specialized care or treatment at KHCC may need to fill out the patient referral form. This form allows their referring physician or healthcare provider to formally request a consultation or treatment services from KHCC.
2. The referral form is also required for patients who are seeking a second opinion or transferring their care from another healthcare facility to KHCC. This ensures that all pertinent medical information is shared and evaluated by the KHCC team before determining the most suitable course of action.
3. Healthcare professionals, such as physicians, specialists, or primary care providers, who wish to refer their patients to the KHCC for consultation, diagnosis, or treatment should complete the patient referral form. This helps in maintaining a streamlined communication process and ensures that all necessary information is provided for proper care coordination.

In summary, the KHCC patient referral form should be filled out by individuals who require specialized medical care from KHCC, referring healthcare providers, and those seeking a second opinion or transferring their care to KHCC. The form requires personal information, details of the referring physician, specific medical needs, and any preferences or requirements for the appointment.

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