Get the free Antenatal Thyroid Clinic Referral Form - CESPHN

ANTENATAL THYROID CLINIC REFERRAL FORM REFERRAL CRITERIA ALL FIELDS MUST BE COMPLETED OR THE FORM WILL BE RETURNED TSH 4mIU/L; TSH 0.01 (i.e. suppressed TSH); Current or past history of Graves disease;

How to fill out antenatal thyroid clinic referral

How to fill out antenatal thyroid clinic referral

1. Obtain the antenatal thyroid clinic referral form from your healthcare provider.
2. Fill out your personal information including your name, address, date of birth, and contact information.
3. Provide information about your medical history, including any previous thyroid issues or medications you are currently taking.
4. Include any relevant lab test results or diagnostic imaging reports that may help in assessing your thyroid health.
5. If you have been referred by another healthcare provider, make sure to include their contact information and any specific reasons for the referral.
6. Double check that all information is filled out accurately and legibly before submitting the referral form.

Who needs antenatal thyroid clinic referral?

1. Pregnant women who have been identified as being at risk for thyroid disorders or have a history of thyroid issues may need an antenatal thyroid clinic referral.
2. Women who have symptoms of thyroid dysfunction during pregnancy, such as fatigue, weight changes, or mood disturbances, may also benefit from a referral to the antenatal thyroid clinic.

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What is antenatal thyroid clinic referral?

Antenatal thyroid clinic referral is a form used to refer pregnant women with thyroid conditions to specialized antenatal care for monitoring and management.

Who is required to file antenatal thyroid clinic referral?

Healthcare providers such as obstetricians, endocrinologists, or primary care physicians are required to file antenatal thyroid clinic referrals.

How to fill out antenatal thyroid clinic referral?

The referral form typically requires information about the patient's thyroid condition, pregnancy status, and any relevant medical history. It must be filled out accurately and completely.

What is the purpose of antenatal thyroid clinic referral?

The purpose of antenatal thyroid clinic referral is to ensure that pregnant women with thyroid conditions receive appropriate monitoring and care to prevent any adverse effects on the pregnancy.

What information must be reported on antenatal thyroid clinic referral?

Information such as the patient's thyroid condition details, current pregnancy status, relevant medical history, and any specific requirements for antenatal care must be reported on the referral form.