Get the free PAEDIATRIC AMPUTEE CLINIC REFERRAL FORM FAX TO NPCC HEALTH ...
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547 COLERIDGE AVENUE ST. CATHERINE, ON L2T 4C2 TEL: 9056882553 GROUP.GENERAL REFERRAL FORM FAX: 9056883230 Email: Niagara group.ca CLIENT Information Filename:o Mandate of Birth:MM/DD/YYYYStreet Address:
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How to fill out paediatric amputee clinic referral
How to fill out paediatric amputee clinic referral
01
Gather all relevant medical information and history of the pediatric patient.
02
Obtain referral form for the paediatric amputee clinic from the healthcare provider or the clinic itself.
03
Fill out the referral form completely and accurately. Provide detailed information about the patient's amputation, medical condition, and any specific concerns.
04
Include any relevant supporting documents, such as medical reports, imaging results, and previous prosthetic fitting records.
05
Ensure that all contact information for the referring healthcare provider and the patient is provided correctly.
06
Submit the completed referral form and supporting documents to the paediatric amputee clinic through the designated submission process, which may include mail, fax, or online submission.
07
Follow up with the clinic to confirm receipt of the referral and any additional steps required for the patient's evaluation and appointment scheduling.
Who needs paediatric amputee clinic referral?
01
Any pediatric patient who has undergone an amputation or has a congenital limb deficiency may need a paediatric amputee clinic referral.
02
This can include children who require prosthetic evaluation, fitting, and ongoing care.
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What is paediatric amputee clinic referral?
A paediatric amputee clinic referral is a formal request for evaluation and treatment of children who have undergone amputation. This referral is usually made to specialized clinics that focus on the rehabilitation and support of paediatric amputees.
Who is required to file paediatric amputee clinic referral?
Typically, healthcare providers such as pediatricians, orthopedic surgeons, or rehabilitation specialists are required to file a paediatric amputee clinic referral on behalf of the child.
How to fill out paediatric amputee clinic referral?
To fill out a paediatric amputee clinic referral, the healthcare provider should complete a referral form that includes patient information, medical history, details about the amputation, and the specific services requested.
What is the purpose of paediatric amputee clinic referral?
The purpose of paediatric amputee clinic referral is to ensure that children who require care after amputation receive appropriate medical evaluation, treatment options, and rehabilitation services tailored to their needs.
What information must be reported on paediatric amputee clinic referral?
The referral must include the child's full name, date of birth, medical history, details of the amputation, contact information for the referrer, and any specific requests for services.
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