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General Referral Form
Patient
NameGenderAddress (number, street, city, province, postal code)
Personal Health Numerate of BirthPhoneEmail AddressUsual Drugstore (name, location, phone)Referred By
Reorganization/Clinic
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How to fill out general referral docx
01
Open the general referral docx file
02
Fill in the patient's personal information such as name, date of birth, address, and contact details
03
Include details on the reason for referral and any relevant medical history
04
Provide information on the referring physician and any specific instructions or requirements
05
Review the completed referral docx for accuracy and completeness before submitting
Who needs general referral docx?
01
Healthcare providers who are referring a patient to another specialist or facility
02
Patients who are seeking a referral from their primary care physician for further evaluation or treatment
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