Get the free GA193C - Referral Fax Form SCA - TD.docx

REQUEST FOR SERVICES Nonsurgical Care Associates to: 18662024492If this request is emergent in nature or your patient needs to be seen on an ASAP basis please call our office at (812) 4776103. We

How to fill out ga193c - referral fax

How to fill out ga193c - referral fax

1. To fill out the GA193C referral fax, follow these steps:
2. Begin by entering the date on the top right corner of the form.
3. In the 'Patient Information' section, enter the patient's full name, date of birth, gender, and contact information.
4. Provide the referring physician's information, including their name, contact number, and fax number.
5. Indicate the reason for the referral by selecting the appropriate checkboxes or providing a brief description in the 'Reason for Referral' section.
6. If applicable, specify any relevant medical conditions or diagnosis in the 'Medical Condition(s)' field.
7. Enter any additional notes or comments in the 'Additional Information' section.
8. Review the completed form for accuracy and make any necessary corrections.
9. Finally, fax the completed GA193C referral form to the designated recipient.
10. Note: It is recommended to keep a copy of the fax transmission confirmation for your records.

Who needs ga193c - referral fax?

1. The GA193C referral fax is typically required by healthcare professionals or medical facilities who need to refer patients to another healthcare provider or specialist.
2. This form is commonly used in situations where a patient's condition requires specialized care or expertise beyond the scope of the referring physician's practice.
3. By filling out the GA193C referral fax, healthcare professionals ensure that all necessary information is communicated efficiently and accurately for the smooth coordination of patient care.

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What is ga193c - referral fax?

GA193C - referral fax is a form used to refer a patient to another healthcare provider or facility for specialized care or treatment.

Who is required to file ga193c - referral fax?

Healthcare providers, such as doctors or specialists, are required to file GA193C - referral fax when referring a patient to another provider for specialized care.

How to fill out ga193c - referral fax?

GA193C - referral fax should be filled out with the patient's information, reason for referral, medical history, and any relevant diagnostic or treatment information. It should then be sent to the receiving healthcare provider.

What is the purpose of ga193c - referral fax?

The purpose of GA193C - referral fax is to ensure that patients receive appropriate and timely specialized care from other healthcare providers or facilities.

What information must be reported on ga193c - referral fax?

GA193C - referral fax must include the patient's name, date of birth, contact information, reason for referral, relevant medical history, and any diagnostic or treatment information.