Get the free MOHS FAX REFERRAL REQUEST DATE: Number of Pages:

FAX REFERRAL SEQUESTRATE: Number of Pages: Phone: 559.439.3000Referral Fax: 559.4353229 5701 N. West Ave Fresno, CA 93711www.boswelldermatology.come. Scott Boswell, MD Jared Land, MD Christina Stepson,

How to fill out mohs fax referral request

How to fill out mohs fax referral request

1. To fill out a Mohs fax referral request, follow these steps:
2. Begin by entering the patient's personal information, including their full name, date of birth, and contact details.
3. Next, provide information about the referring physician or clinic, including their name, address, and contact information.
4. Specify the reason for the referral, including any relevant medical history, symptoms, or concerns.
5. If applicable, provide details about any previous treatments or procedures related to the condition being referred.
6. Include any relevant medical records, test results, or imaging reports to support the referral.
7. Complete the form by signing and dating it, ensuring all required fields are filled out accurately.
8. Fax the completed referral request to the appropriate Mohs surgery center or dermatologist's office.
9. Keep a copy of the referral request for your records.

Who needs mohs fax referral request?

1. Mohs fax referral requests are typically needed by dermatologists or general practitioners referring a patient to a Mohs surgery center.
2. These requests may be necessary when a biopsy or skin cancer diagnosis requires specialized treatment or surgical intervention.
3. Mohs surgery is a precise surgical technique used to treat common types of skin cancer, such as basal cell carcinoma and squamous cell carcinoma.
4. The referral request helps ensure that the patient receives appropriate care from a qualified Mohs surgeon.

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What is mohs fax referral request?

The Mohs fax referral request is a formal request submitted via fax for patients to receive Mohs micrographic surgery, a precise surgical technique used to treat skin cancer.

Who is required to file mohs fax referral request?

The healthcare providers, typically dermatologists or primary care physicians, who are referring patients for Mohs surgery are required to file this fax referral request.

How to fill out mohs fax referral request?

To fill out a Mohs fax referral request, the referring physician must provide patient details, the reason for the referral, and any pertinent medical history, ensuring all required fields are accurately completed.

What is the purpose of mohs fax referral request?

The purpose of the Mohs fax referral request is to provide necessary information to the Mohs surgeon to facilitate the scheduling and preparation for the surgery.

What information must be reported on mohs fax referral request?

The information that must be reported includes patient demographics, clinical history, specific diagnosis, details of previous treatments, and any additional relevant medical information.