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7096.08.16154.01Sunset Date: 6/2024Place Patient Label Inside This Book Referral Page 1 of 1*** This section refers to the entire plan. If individual orders need a different interval, please indicate

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How to fill out referral and consent forms

01

Obtain the referral form from the appropriate source (e.g. doctor, agency, school)

02

Read through the form carefully to understand the information required

03

Fill out personal information such as name, address, contact details

04

Provide the reason for referral and any relevant background information

05

Sign and date the form to indicate your consent and agreement

Who needs referral and consent forms?

01

Individuals seeking services or assistance from a professional or organization

02

Healthcare providers referring patients to specialists or other facilities

03

Schools or agencies referring students or clients for additional support

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What is referral and consent forms?

Referral and consent forms are documents used to authorize the transfer of a patient from one health care provider to another, and to obtain the patient's agreement for treatment.

Who is required to file referral and consent forms?

Health care providers, patients, and guardians are typically required to complete and file referral and consent forms.

How to fill out referral and consent forms?

Referral and consent forms can be filled out by providing relevant patient information, treatment details, and obtaining signatures from both the health care provider and the patient.

What is the purpose of referral and consent forms?

The purpose of referral and consent forms is to ensure that patients receive appropriate care, protect the rights of patients, and facilitate communication between health care providers.

What information must be reported on referral and consent forms?

Information such as patient demographics, medical history, treatment plan, informed consent details, and signatures of parties involved must be reported on referral and consent forms.

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