Get the free Gastroenterology Motility Lab Referral Form - June 2020 - med dartmouth-hitchcock

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Fax completed form to: (603) 6764068. We will contact the patient. ** Denotes required fields to complete the referral. Gastrointestinal Motility, Esophageal, and Swallowing Disorders Center Motility

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How to fill out gastroenterology motility lab referral

01

To fill out a gastroenterology motility lab referral, follow the steps below:

02

Start by providing the patient's personal information such as full name, date of birth, and contact details.

03

Include the patient's medical history, including any relevant diagnoses, current medications, and previous treatments.

04

Specify the reason for the referral to the gastroenterology motility lab, describing the symptoms or concerns that require further evaluation.

05

Indicate any relevant test results or imaging studies that have already been conducted.

06

Include any additional information or specific instructions the lab should be aware of.

07

Sign and date the referral form before submitting it to the gastroenterology motility lab.

Who needs gastroenterology motility lab referral?

01

Gastroenterology motility lab referral may be required for individuals who are experiencing digestive issues or symptoms related to the motility of the gastrointestinal tract.

02

Patients with conditions such as chronic constipation, chronic diarrhea, gastroesophageal reflux disease (GERD), dysphagia (difficulty swallowing), gastroparesis, irritable bowel syndrome (IBS), or suspected motility disorders may need a referral for further evaluation at a gastroenterology motility lab.

03

Medical professionals, such as primary care physicians or gastroenterologists, can determine if a patient requires a referral based on their symptoms and medical history.

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What is gastroenterology motility lab referral?

A gastroenterology motility lab referral is a formal request made by a healthcare provider for a patient to undergo motility testing, which assesses the function and movement of the gastrointestinal tract.

Who is required to file gastroenterology motility lab referral?

Typically, the referring healthcare provider, such as a gastroenterologist or primary care physician, is required to file the gastroenterology motility lab referral for their patients.

How to fill out gastroenterology motility lab referral?

To fill out a gastroenterology motility lab referral, the provider must include patient information, clinical history, specific tests requested, and any relevant medical details that justify the referral.

What is the purpose of gastroenterology motility lab referral?

The purpose of a gastroenterology motility lab referral is to diagnose disorders of motility in the gastrointestinal tract, helping to guide treatment options based on the results of the tests performed.

What information must be reported on gastroenterology motility lab referral?

The referral must report patient demographics, insurance information, clinical symptoms, medical history, and details about the specific tests being requested.

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