Get the free KHCC Dialysis referral form

KIDNEY AND HYPERTENSION CARE CENTER, PA 1213 Hermann Dr., Suite 460 Houston, Texas 77004 Tel: (713) 5206222 Fax: (713) 5206223 Monday Friday: 8:00 am to 5:00pm., For after hours support dial our office

How to fill out khcc dialysis referral form

How to fill out khcc dialysis referral form

1. To fill out the KHCC dialysis referral form, follow these steps:
2. Start by entering the patient's personal details, such as name, date of birth, and contact information.
3. Provide the patient's medical history, including any previous diagnoses, current medications, and underlying conditions.
4. Indicate the reason for the referral and the specific dialysis treatment needed.
5. Attach any relevant medical documents or test results that support the referral.
6. Make sure to include the name and contact information of the referring physician.
7. Review the form for any errors or missing information before submitting it.
8. Submit the completed form to the appropriate department or healthcare provider for processing.
9. Keep a copy of the form for your records.

Who needs khcc dialysis referral form?

1. The KHCC dialysis referral form is required for patients who need to undergo dialysis treatment at KHCC (King Hussein Cancer Center). It is typically used for individuals with kidney disease or renal failure who require specialized dialysis care.

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