Get the free Pediatric rehabilitation referral fax form

Pediatric rehabilitation referral fax form 19250 S.W. 65th Ave. Medical Plaza Office Building 1, Suite 125 Tualatin, OR 97062 Program Phone: 5036921670 Program Fax: 5036921669 Legacy Meridian Park

How to fill out pediatric rehabilitation referral fax

How to fill out pediatric rehabilitation referral fax

1. Gather all necessary information including patient's name, date of birth, contact information, and medical history.
2. Fill out the referring physician's name, contact information, and reason for referral.
3. Provide details about the patient's current condition and specific therapy services needed.
4. Include any relevant medical reports or test results that support the referral.
5. Double check all information for accuracy before sending the fax.

Who needs pediatric rehabilitation referral fax?

1. Pediatricians referring patients for specialized rehabilitation services.
2. Parents or guardians seeking therapeutic interventions for their children.
3. Healthcare providers coordinating care for children with complex medical needs.

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What is pediatric rehabilitation referral fax?

Pediatric rehabilitation referral fax is a document used to refer a pediatric patient to rehabilitation services.

Who is required to file pediatric rehabilitation referral fax?

Healthcare providers, primary care physicians, and specialists are required to file pediatric rehabilitation referral fax.

How to fill out pediatric rehabilitation referral fax?

To fill out pediatric rehabilitation referral fax, one must provide patient information, reason for referral, medical history, and contact information.

What is the purpose of pediatric rehabilitation referral fax?

The purpose of pediatric rehabilitation referral fax is to facilitate the referral process for pediatric patients in need of rehabilitation services.

What information must be reported on pediatric rehabilitation referral fax?

Patient demographics, diagnosis, current medications, previous treatments, and insurance information must be reported on pediatric rehabilitation referral fax.