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REFERRING OFFICE: FAX REQUESTS TO (703) 5911849 PATIENTS: CALL (703) 6214501 FOR APPOINTMENT Tariq A. Aziz, MD, FACE Subhash B. Jazz, MD, FACE Casey R. Benton, MD, FACE Rachel L. Berger, MD, FACE

How to fill out referring office fax requests

How to fill out referring office fax requests

1. Obtain the referring office fax request form.
2. Read the instructions on the form carefully.
3. Fill in the required information in each section of the form.
4. Provide the name and contact information of the referring office.
5. Include the patient's information, such as name, date of birth, and medical record number.
6. Specify the reason for the request and the type of information needed.
7. If applicable, provide any relevant medical history or previous test results.
8. Double-check all the information provided for accuracy.
9. Sign and date the form.
10. Submit the completed form by fax to the appropriate recipient.

Who needs referring office fax requests?

1. Referring physicians or healthcare professionals who need to request specific information from another office via fax.

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What is referring office fax requests?

Referring office fax requests refer to the documentation sent via fax by a referring office to request specific services or information from another office or agency.

Who is required to file referring office fax requests?

Referring office fax requests are typically required to be filed by offices or organizations that need to refer cases or seek assistance from other agencies.

How to fill out referring office fax requests?

To fill out referring office fax requests, one must provide the necessary details, including the referring office's information, the recipient's details, description of the request, and any relevant reference numbers.

What is the purpose of referring office fax requests?

The purpose of referring office fax requests is to facilitate communication and ensure that requests for assistance or information are documented and processed efficiently.

What information must be reported on referring office fax requests?

Information required on referring office fax requests includes the referring office's contact details, recipient's information, specifics about the case or request, and any required supporting documentation.