Get the free Anticoagulation Clinic Referral Form - UK HealthCare

Anticoagulation Clinic Referral Form **Phone: (864) 5223340 **Please fax referral form to (864) 5223345** Patient Name___ Medical Record #___ Date of Birth ___/___/___ Telephone Number (___)______Alternate

How to fill out anticoagulation clinic referral form

How to fill out anticoagulation clinic referral form

1. Obtain the anticoagulation clinic referral form from the clinic or download it online.
2. Fill out patient information including name, date of birth, address, contact information.
3. Provide details about the reason for referral and any medical history that may be relevant.
4. Specify the type of anticoagulation therapy the patient is currently on, if applicable.
5. Include any relevant labs or test results that may help in evaluating the patient's condition.
6. Sign and date the form as the referring healthcare provider.
7. Submit the completed form to the anticoagulation clinic for review.

Who needs anticoagulation clinic referral form?

1. Patients who are on anticoagulation therapy such as warfarin or other blood thinners.
2. Patients with conditions such as atrial fibrillation, deep vein thrombosis, pulmonary embolism, or mechanical heart valves.
3. Patients who require close monitoring and management of their anticoagulation therapy.

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What is anticoagulation clinic referral form?

It is a form used to refer patients to an anticoagulation clinic for management of their blood thinning medication.

Who is required to file anticoagulation clinic referral form?

Healthcare providers are required to file the form on behalf of their patients who need anticoagulation therapy.

How to fill out anticoagulation clinic referral form?

The form typically requires patient demographics, medical history, current medications, and reason for referral to be filled out by the healthcare provider.

What is the purpose of anticoagulation clinic referral form?

The purpose is to ensure that patients receiving anticoagulation therapy are properly monitored and managed by a specialized clinic.

What information must be reported on anticoagulation clinic referral form?

Patient's demographic information, medical history, current medications, reason for referral, and relevant lab results should be reported.