Get the free Wichita Specialty Clinic Referral Form - childrensmercy

Wichita Specialty Clinics 3243 E. Murdock, Suite 201 Wichita, KS 67208 Phone: (316) 500-8900 APPOINTMENT and MEDICAL RECORDS FORM (For Physician Office Use Only) New Clinic Appointment Please attach

How to fill out wichita specialty clinic referral

How to fill out Wichita Specialty Clinic Referral:

1. Start by obtaining the referral form from your primary care physician or healthcare provider.
2. Fill out the patient information section, including your full name, date of birth, address, and contact information.
3. Provide your insurance information, such as the name of your insurance provider, policy number, and group number.
4. Specify the reason for the referral, including any symptoms or medical concerns that require specialized care.
5. Indicate the preferred specialty clinic or specialist you are being referred to, if you have a specific one in mind.
6. If applicable, include any relevant medical history, previous treatments, or medications you are currently taking.
7. Ensure that your primary care physician or healthcare provider signs and dates the referral form.
8. Before submitting the referral form, make a copy for your own records.
9. Contact the Wichita Specialty Clinic to confirm that they have received your referral and to schedule an appointment.

Who needs Wichita Specialty Clinic Referral:

1. Patients who require specialized medical care beyond the capabilities of their primary care physician or healthcare provider.
2. Individuals who have a specific condition or symptoms that require expertise from a specialist in a particular field.
3. Patients who have been recommended by their primary care physician or healthcare provider to seek specialized consultation or treatment.
4. Individuals who may need further diagnostic tests, procedures, or surgeries that can only be performed by specialists at the Wichita Specialty Clinic.

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What is wichita specialty clinic referral?

Wichita specialty clinic referral is a document that is used to refer a patient to a specialty clinic in Wichita for specialized medical care.

Who is required to file wichita specialty clinic referral?

Healthcare providers such as doctors, nurses, or other medical professionals are required to file wichita specialty clinic referral.

How to fill out wichita specialty clinic referral?

To fill out wichita specialty clinic referral, the healthcare provider must provide the patient's information, reason for referral, medical history, and any relevant test results.

What is the purpose of wichita specialty clinic referral?

The purpose of wichita specialty clinic referral is to ensure that patients receive the appropriate specialized medical care they need.

What information must be reported on wichita specialty clinic referral?

The information that must be reported on wichita specialty clinic referral includes patient demographics, reason for referral, medical history, current medications, and relevant test results.