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Enclosure Department of Health Services State of Callforma-Health and Human Services Agency NEWBORN REFERRAL (NOT AN APPLICATION FOR MEDICAL) (PLEASE USE INK AND PRESS FIRMLY.) The Newborn Referral
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How to fill out newborn referral not an
How to fill out a newborn referral not an:
01
Start by gathering all the necessary information about the newborn, such as full name, date of birth, and any relevant medical history.
02
Next, fill out the referring healthcare provider's information, including their name, contact details, and professional credentials.
03
Provide the reason for the referral, specifying the concerns or conditions that require further evaluation or specialized care for the newborn.
04
Indicate the preferred specialist or facility for the referral, if applicable. Include their name, contact information, and any specific instructions for the referral process.
05
Fill out the parent or guardian's information, including their name, contact details, and relationship to the newborn.
06
Finally, review the completed referral form for accuracy and completeness before submitting it to the appropriate healthcare provider or facility.
Who needs newborn referral not an:
01
Newborns who require further evaluation or specialized care for specific medical conditions or concerns.
02
Parents or guardians who have been advised by their healthcare provider to seek specialized medical attention for their newborn.
03
Healthcare providers who have identified the need for a specialist's expertise in managing a newborn's health condition.
Note: It is essential to consult with a healthcare provider for specific guidance on filling out a newborn referral form, as requirements may vary depending on the healthcare system or facility.
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