Get the free Patient Referral Form - INHS Wellness
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501 N. River point Blvd., Suite #245 Spokane, WA 99202 (509) 2328145 www.wellness.inhs.org FAX (509) 2328151Patient Referral Form * Indicates required information *Name: *DOB: *Sex: *Today's Date:
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How to fill out patient referral form
How to fill out patient referral form
01
To fill out a patient referral form, follow these steps:
02
Start by adding the patient's personal information, such as full name, date of birth, and contact details.
03
Provide the reason for the referral. Include information about the patient's condition, symptoms, or the specific service needed.
04
Include relevant medical history, such as previous diagnoses, treatments, or medications.
05
Specify any additional information required for the referral, such as preferred healthcare providers, specialists, or facilities.
06
Make sure to sign and date the form to validate the referral.
07
Double-check all the information provided for accuracy and completeness before submitting the form.
08
Submit the filled-out referral form to the appropriate healthcare professional or facility as instructed.
Who needs patient referral form?
01
Patient referral forms are typically needed in the following situations:
02
- When a patient needs to be referred to a specialist for further evaluation or treatment.
03
- When a patient needs specific diagnostic tests that require a referral.
04
- When a patient needs to be transferred to another healthcare facility for advanced care.
05
- When a healthcare provider wants to recommend a particular specialist or healthcare service to a patient.
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