Get the free DIRECT ACCESS FAX REFERRAL FORM - Unity Healthcare
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Khaled Hammond, MD 1345 Unity Place, Suite 310B Lafayette, IN 47905 Phone: 765.446.5220 Fax: 765.446.5221 www.lafayetteneurology.comDIRECT ACCESS FAX REFERRAL FORM Please complete this form and fax
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How to fill out direct access fax referral
How to fill out direct access fax referral
01
To fill out a direct access fax referral, follow these steps:
02
Start by obtaining the necessary form from the direct access provider.
03
Fill out the patient's personal information, including their name, address, and contact details.
04
Provide relevant medical history and any recent test results.
05
Specify the reason for the referral and the type of specialist needed.
06
Include any additional notes or instructions for the specialist.
07
Double-check all the information for accuracy and completeness before sending the referral via fax.
Who needs direct access fax referral?
01
Direct access fax referral is often required by patients who want to see a specialist without a prior consultation with a primary care physician.
02
It is also necessary for individuals who have received a recommendation for a specific specialist from their primary care physician and need to schedule an appointment directly.
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What is direct access fax referral?
Direct access fax referral is a process that allows healthcare providers to refer patients directly for specific services or consultations via fax, bypassing traditional referral methods.
Who is required to file direct access fax referral?
Healthcare providers who need to refer patients for specialized services or consultations are required to file direct access fax referrals.
How to fill out direct access fax referral?
To fill out a direct access fax referral, providers must complete a specific form that includes patient information, details of the service requested, and any necessary medical history.
What is the purpose of direct access fax referral?
The purpose of direct access fax referral is to streamline the referral process, improve communication between providers, and ensure timely access to specialized services for patients.
What information must be reported on direct access fax referral?
Information that must be reported includes the patient's personal details, the referring provider's information, the service requested, and any relevant medical history or notes.
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