Get the free 6066-13MR, Medical Genetics Referral Form - The Center for Genetics

THE CENTER FOR MEDICAL GENETICS FOR CMG OFFICE USE ONLY 15 Old Rollins ford Road, Suite 201, Dover, NH 03820 Phone: (603) 516-0092 ? Fax: (603) 516-0093 Thank you for your referral. We will contact

How to fill out 6066-13mr medical genetics referral

How to fill out 6066-13mr medical genetics referral:

1. Begin by gathering all necessary patient information, such as their full name, date of birth, contact information, and relevant medical history.
2. Indicate the reason for the referral in the designated section, providing a clear and concise explanation of why the patient requires medical genetics services.
3. Specify the referring healthcare provider's details, including their name, address, and contact information.
4. If applicable, include the referring healthcare provider's national provider identifier (NPI) and their signature.
5. Make sure to accurately indicate any relevant insurance information, including the patient's insurance provider and policy number.
6. If the patient has been seen by a genetic counselor or specialist prior to the referral, provide their details and include any relevant documentation or test results.
7. Provide a brief summary of the patient's genetic history, including any known genetic conditions within the family.
8. If there are any specific genetic tests that the referring healthcare provider is requesting, clearly indicate them and provide a rationale for their necessity.
9. Lastly, review the completed referral form to ensure all fields are accurately filled out before submitting it to the appropriate medical genetics department.

Who needs 6066-13mr medical genetics referral:

1. Individuals who have been diagnosed with or are suspected to have a genetic disorder may require a medical genetics referral.
2. Patients who have a family history of genetic conditions and wish to understand their risk may seek a medical genetics referral.
3. Pregnant women who have received abnormal prenatal screening results or have a family history of genetic disorders may benefit from a medical genetics referral.
4. Healthcare providers who require the expertise of genetic counselors or geneticists in providing accurate diagnosis, risk assessment, and management strategies for their patients may initiate a medical genetics referral.

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What is 6066-13mr medical genetics referral?

6066-13mr medical genetics referral is a form used to refer patients to medical genetics specialists for evaluation and testing.

Who is required to file 6066-13mr medical genetics referral?

Healthcare providers such as physicians, genetic counselors, and other medical professionals are required to file 6066-13mr medical genetics referral when referring patients for genetic evaluation.

How to fill out 6066-13mr medical genetics referral?

To fill out 6066-13mr medical genetics referral, healthcare providers need to provide patient information, medical history, reason for referral, and any relevant test results.

What is the purpose of 6066-13mr medical genetics referral?

The purpose of 6066-13mr medical genetics referral is to allow patients to receive specialized genetic evaluation and testing to determine if they have a genetic condition or are at risk for one.

What information must be reported on 6066-13mr medical genetics referral?

Information such as patient demographics, medical history, family history, reason for referral, and any relevant test results must be reported on 6066-13mr medical genetics referral.