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Consult/Referral FormReferral Line 5173372725
Retinal Specialists:
O'Neil Diskette, M.D.
Ahmed A. ElSanhouri, M.D.
Corneal Specialist:
Matthew M. Yeoman, M.D. Referral Fax 5173371380Affiliated Offices:
Alma
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How to fill out consultreferral form
How to fill out consultreferral form
01
Obtain a consultreferral form from the appropriate department or organization.
02
Complete all required fields on the form, such as patient information, reason for referral, and referring provider information.
03
Attach any relevant documents or test results that support the referral.
04
Obtain any necessary signatures from the referring provider or patient, if required.
05
Submit the completed form to the appropriate department or organization as specified on the form.
Who needs consultreferral form?
01
Healthcare providers who wish to refer a patient to a specialist or another department.
02
Patients who have been recommended for a consultation with a specialist or another healthcare provider.
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What is consultreferral form?
The consultreferral form is a document used to refer a patient to another healthcare provider for consultation or further treatment.
Who is required to file consultreferral form?
Healthcare providers such as doctors, nurses, and other medical professionals are required to file consultreferral forms when referring a patient to another provider.
How to fill out consultreferral form?
The consultreferral form typically requires the patient's information, reason for referral, provider's information, and any relevant medical history. The form can be filled out electronically or on paper.
What is the purpose of consultreferral form?
The purpose of the consultreferral form is to ensure seamless communication between healthcare providers and to provide the receiving provider with necessary information about the patient's condition and medical history.
What information must be reported on consultreferral form?
The consultreferral form must include the patient's name, date of birth, reason for referral, current medications, past medical history, and any relevant test results.
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