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Outpatient Consult Request for Oncology Services 1500 East Medical Center Drive Ann Arbor, MI 481095410Complete consult request form and fax with relevant progress notes, diagnostic results, labs

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How to fill out outpatient consult request for

01

Start by providing your personal information such as name, date of birth, and contact details.

02

Mention the reason for the outpatient consult request, including any specific symptoms or medical concerns.

03

Specify the preferred date and time for the consultation, if applicable.

04

If you have any previous medical history related to the issue, include relevant details.

05

If you have any medical reports or test results that are relevant to the consultation, attach them.

06

Mention any medication you are currently taking or any allergies you have.

07

Lastly, submit the completed outpatient consult request form to the designated department or healthcare provider.

Who needs outpatient consult request for?

01

Anyone who requires a medical consultation on an outpatient basis can submit an outpatient consult request.

02

This may include individuals experiencing a non-emergency medical issue, seeking a second opinion, or in need of follow-up care.

03

Patients who are referred by their primary care physicians or require specialized medical advice may also need to fill out an outpatient consult request.

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What is outpatient consult request for?

Outpatient consult request is for seeking medical advice or opinion from a specialist without the need for hospitalization.

Who is required to file outpatient consult request for?

Outpatient consult request can be filed by patients, primary care physicians, or other healthcare providers.

How to fill out outpatient consult request for?

To fill out an outpatient consult request, one must provide patient information, reason for consultation, relevant medical history, and any supporting documents.

What is the purpose of outpatient consult request for?

The purpose of outpatient consult request is to obtain expert medical advice or opinion for non-emergency medical situations.

What information must be reported on outpatient consult request for?

The outpatient consult request must include patient demographics, reason for consultation, relevant medical history, current medication, and any previous consultations.

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