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Heart Rhythm Device Implant Referral Form Island Health Heart Health Department 17 June2021PLEASE AFFIX PATIENT LaBelle PLEASE AFFIX PATIENT LABEL LEASE ASE PATIENT LABELREQUEST FOR HEART RHYTHM DEVICE
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What is does this patient have?
This patient has a medical condition that requires further evaluation and treatment.
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The patient's healthcare provider is required to file the necessary documentation.
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The healthcare provider must accurately document the patient's medical history, symptoms, and any test results.
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The purpose is to accurately diagnose the patient's medical condition and determine the most appropriate treatment plan.
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The report must include the patient's personal information, medical history, symptoms, test results, and any prescribed medications.
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