Get the free PHN Nursing Referral Form 11-10-10.doc - vchca

VENTURA COUNTY PUBLIC HEALTH NURSING REFERRAL 2125 Knoll Drive Ventura, Ca 93003 http://www.vchca.org/ph Office: (805) 654-7600 FAX: (805) 654-7610 This information is intended only for the use b

How to fill out phn nursing referral form

How to fill out PHN nursing referral form:

1. Start by carefully reading the instructions on the form. Make sure you understand the purpose of the form and the information it requires.
2. Begin by providing your personal details in the designated sections. This may include your name, contact information, and any relevant identification numbers.
3. Next, indicate the reason for the referral by selecting the appropriate category or providing a brief explanation. This will help the nursing team understand the specific needs or concerns.
4. Fill in the patient's details, including their name, age, gender, and any medical history or conditions that are pertinent to the referral.
5. Specify the preferred healthcare provider or facility if applicable. This could be a specific nurse, clinic, or hospital based on the patient's needs and preferences.
6. Provide a summary of the patient's current health status and the reason for the referral. Include any symptoms, diagnoses, or treatments they have undergone that led to the need for nursing care.
7. If applicable, attach any relevant medical reports, test results, or supporting documents that may assist the nursing team in understanding the patient's condition better.
8. Review the completed form and ensure all required fields are filled in accurately. Double-check for any spelling errors or missing information.
9. Sign and date the form, indicating your authorization and confirmation of the provided information.
10. Submit the PHN nursing referral form to the appropriate healthcare authority or facility as instructed.

Who needs PHN nursing referral form:

1. Individuals who require specialized nursing care or assistance due to their health condition.
2. Patients who have been referred to a nurse for specific medical treatments, monitoring, or intervention.
3. Healthcare professionals who are responsible for coordinating and managing patient care, and recognize the need for additional nursing support in delivering comprehensive healthcare services.

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