Get the free IMA CLINIC REFERRAL FORM - Impact Medical Associates

IMA Clinic (a division of Health) 6720 104 Street NW Edmonton, AB T6H 2L4 pH: (780) 3065555 FX: (780) 4312554 www.chealth.caIMA CLINIC REFERRAL FORM PATIENT INFORMATION (attach patient label) Patient

How to fill out ima clinic referral form

How to fill out ima clinic referral form

1. To fill out the IMA Clinic referral form, follow these steps:
2. Begin by entering the patient's personal information such as their name, date of birth, address, and contact details.
3. Next, provide details regarding the referring physician or healthcare professional. Include their name, contact information, and any relevant identification numbers.
4. Specify the reason for the referral and provide any necessary medical history or documentation.
5. If applicable, indicate any specific tests or procedures that are requested for the patient.
6. Include any additional relevant information or instructions for the receiving healthcare provider.
7. Review the completed form for accuracy and ensure that all required fields have been filled out.
8. Submit the referral form to the appropriate department or healthcare provider as instructed.
9. Keep a copy of the completed referral form for your records and reference if needed in the future.

Who needs ima clinic referral form?

1. The IMA Clinic referral form is typically needed by patients who require specialized medical care or services that are not provided directly at the clinic. It is used to refer patients to healthcare providers or facilities that have the necessary resources and expertise to address the patient's specific health concerns or conditions. Referrals may be required for services such as consultations with specialists, diagnostic tests, hospital admissions, or other specialized treatments. The referring physician or healthcare professional recognizes the need for further evaluation or management beyond the scope of their own practice and initiates the referral process by filling out the referral form.

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What is ima clinic referral form?

The ima clinic referral form is a document used to refer patients to the ima clinic for medical treatment.

Who is required to file ima clinic referral form?

Healthcare professionals such as doctors, nurses, or medical staff are required to file the ima clinic referral form for their patients.

How to fill out ima clinic referral form?

To fill out the ima clinic referral form, healthcare professionals must provide patient information, medical history, reason for referral, and any relevant medical documents.

What is the purpose of ima clinic referral form?

The purpose of the ima clinic referral form is to ensure that patients receive proper medical treatment and care at the ima clinic.

What information must be reported on ima clinic referral form?

Patient's name, date of birth, contact information, medical history, reason for referral, and any relevant medical documents must be reported on the ima clinic referral form.