HI Hawaii Specialty Pharmacy Gastroenterology Referral Form 2019-2025 free printable template

GASTROENTEROLOGY REFERRAL FORM Please fax to Hawaii Specialty Pharmacy at 8083333682Your HIS Rep: ___ and Tel: ___ Patient Name: Address: City: Home Phone: Email: Soc. Sec #: Date of Birth: Weight:

How to fill out HI Hawaii Specialty Pharmacy Gastroenterology Referral

How to fill out HI Hawaii Specialty Pharmacy Gastroenterology Referral Form

1. Obtain the HI Hawaii Specialty Pharmacy Gastroenterology Referral Form from the official website or your healthcare provider.
2. Fill out the patient's information at the top of the form, including name, date of birth, and contact details.
3. Provide details about the referring physician, including their name, contact number, and practice address.
4. Indicate the patient's medical history relevant to gastroenterology and any current medications they are taking.
5. Clearly document the reason for the referral, including specific symptoms or conditions being assessed.
6. Sign and date the form to verify the information provided is accurate.
7. Submit the completed form to HI Hawaii Specialty Pharmacy via the prescribed method (fax, email, or mail).

Who needs HI Hawaii Specialty Pharmacy Gastroenterology Referral Form?

1. Patients who require specialized gastroenterology services or treatments.
2. Primary care physicians or specialists seeking to refer patients for gastroenterology evaluations.
3. Healthcare providers managing patients with chronic gastrointestinal conditions.

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What is HI Hawaii Specialty Pharmacy Gastroenterology Referral Form?

The HI Hawaii Specialty Pharmacy Gastroenterology Referral Form is a document used by healthcare providers to refer patients for specialized gastroenterology services and medications through HI Hawaii Specialty Pharmacy.

Who is required to file HI Hawaii Specialty Pharmacy Gastroenterology Referral Form?

Healthcare providers, including physicians and specialists, are required to file the HI Hawaii Specialty Pharmacy Gastroenterology Referral Form when referring patients for gastroenterology care and specialized pharmacy services.

How to fill out HI Hawaii Specialty Pharmacy Gastroenterology Referral Form?

To fill out the HI Hawaii Specialty Pharmacy Gastroenterology Referral Form, providers must complete all required sections including patient information, the referring provider's details, the reason for referral, and any relevant medical history or treatment information.

What is the purpose of HI Hawaii Specialty Pharmacy Gastroenterology Referral Form?

The purpose of the HI Hawaii Specialty Pharmacy Gastroenterology Referral Form is to facilitate the referral process for patients requiring gastroenterology services, ensuring accurate information is provided for appropriate management and care.

What information must be reported on HI Hawaii Specialty Pharmacy Gastroenterology Referral Form?

The information that must be reported on the HI Hawaii Specialty Pharmacy Gastroenterology Referral Form includes patient demographics, referring provider information, clinical indication for referral, medication history, and any specific notes relevant to the patient's condition.