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ESQUIVEL MEDICAL CLINIC 31153 Esquivel Road, Victoria, BC, V9A 3N7 Phone: (778) 2654305 Fax: (778) 2654306Request for Exposure Prophylaxis (PrEP) Counselling Patients Full Legal Name: Preferred Name:
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How to fill out prep referral formpdf
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01
To fill out the Prep referral form, follow these steps:
02
Open the Prep referral form PDF on your computer or device.
03
Start by filling out the header section of the form. This includes your name, contact information, and the date.
04
Next, provide the details of the patient who is being referred for Prep. This will include their name, date of birth, and contact information.
05
Indicate the reason for the referral and provide any relevant medical history or notes in the designated sections.
06
The form may also require you to select the appropriate Prep medication and dosage for the patient.
07
If there are any additional instructions or comments, make sure to include them in the specified section.
08
Once you have completed filling out the form, review it for accuracy and completeness.
09
Finally, save a copy of the filled-out form for your records and submit it to the appropriate recipient as instructed.
Who needs prep referral formpdf?
01
The Prep referral form is typically needed by healthcare professionals or medical practitioners who are referring patients for pre-exposure prophylaxis (Prep) treatment.
02
This form helps to streamline the referral process and ensure that all necessary information is provided for the patient's Prep treatment.
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What is prep referral formpdf?
Prep referral form pdf is a document used to refer a patient to a pre-exposure prophylaxis (PrEP) program for HIV prevention.
Who is required to file prep referral formpdf?
Healthcare providers, doctors, or clinicians who determine that a patient may benefit from PrEP are required to file the prep referral form pdf.
How to fill out prep referral formpdf?
The prep referral form pdf must be completed with the patient's information, medical history, risk factors, and the healthcare provider's recommendation for PrEP.
What is the purpose of prep referral formpdf?
The purpose of prep referral form pdf is to facilitate the referral process for patients who may benefit from PrEP as part of HIV prevention efforts.
What information must be reported on prep referral formpdf?
The prep referral form pdf must include the patient's demographics, medical history, risk factors for HIV exposure, and the healthcare provider's recommendation for PrEP.
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