Get the free Orthopaedic CP Clinic Referral Form

Orthopedic Cerebral Palsy Clinic Orthopedics: Tel: 604 875 2345 ext 3187 / Fax: 604 875 2275 www.bcchildrens.ca/orthocpclinic Orthopedic CP Clinic Referral Form To be completed by referring physician

How to fill out orthopaedic cp clinic referral

How to fill out orthopaedic cp clinic referral?

Start by gathering the necessary information:

1. Patient's full name
2. Date of birth
3. Contact information (address, phone number)
4. Insurance information
5. Referring physician's name and contact details

Provide a brief medical history:

1. Include relevant diagnoses or conditions of the patient
2. Mention any prior treatments or surgeries related to orthopaedic issues
3. Note any ongoing medications or allergies

Describe the reason for the referral:

1. Specify the orthopaedic concern or condition that requires evaluation
2. Explain any symptoms or limitations the patient is experiencing
3. If applicable, include any recent imaging or test results

Include any relevant supporting documents or reports:

1. Attach copies of imaging results (X-rays, MRI, CT scans, etc.)
2. Include any previous orthopaedic consultations or treatment notes

Indicate any specific requests or concerns:

1. If there are particular aspects the referring physician wants the orthopaedic specialist to address, mention them here
2. If there are any specific questions or goals for the referral, include them as well

Sign and date the referral:

1. Ensure that the referring physician signs and dates the referral document
2. Double-check for accuracy and completeness before submitting it

Who needs orthopaedic cp clinic referral?

1. Patients who require specialized orthopaedic care for conditions or injuries related to the musculoskeletal system.
2. Individuals who have received a diagnosis or treatment recommendation from their primary care physician that requires the expertise of an orthopaedic specialist.
3. Patients who may have ongoing orthopaedic issues that require ongoing management or treatment.

Remember, it is crucial to consult with the patient's insurance provider or the specific clinic's guidelines for any additional requirements or forms that need to be filled out.

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What is orthopaedic cp clinic referral?

Orthopaedic CP clinic referral is a process where patients with cerebral palsy are referred to a specialized clinic for orthopaedic treatment and care.

Who is required to file orthopaedic cp clinic referral?

Orthopaedic CP clinic referral can be filed by healthcare providers, physical therapists, or physicians who are treating the patient with cerebral palsy.

How to fill out orthopaedic cp clinic referral?

To fill out orthopaedic CP clinic referral, healthcare providers need to include patient's medical history, current symptoms, and any relevant imaging or test results.

What is the purpose of orthopaedic cp clinic referral?

The purpose of orthopaedic CP clinic referral is to ensure that patients with cerebral palsy receive specialized orthopaedic care and treatment.

What information must be reported on orthopaedic cp clinic referral?

Information such as patient's medical history, current symptoms, and relevant imaging or test results must be reported on orthopaedic CP clinic referral.