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1302 Sunset Avenue Clinton, NC 28328 phone: 910.490.1269 fax: 910.490.1317 info@thrivesampson.comPHYSICAL THERAPY REFERRAL Patient Name:___ DOB___ Patient Telephone:___ Diagnosis / Complaint___TREATMENT:

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How to fill out fax referral form 8511

01

Obtain the fax referral form 8511 from the appropriate department or agency.

02

Fill out the patient's personal information such as name, date of birth, and contact information.

03

Provide details of the referral, including the reason for the referral and any specific instructions or requirements.

04

Make sure to include the referring physician's information and signature on the form.

05

Double-check the completed form for accuracy and legibility before faxing it to the intended recipient.

Who needs fax referral form 8511?

01

Healthcare providers who are referring a patient to another healthcare facility or specialist typically need to fill out fax referral form 8511.

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What is fax referral form 8511?

Fax referral form 8511 is a document used for referring a patient to a specialist or another healthcare provider via fax.

Who is required to file fax referral form 8511?

Healthcare providers such as doctors, nurses, or medical offices are required to file fax referral form 8511 when referring a patient to another provider.

How to fill out fax referral form 8511?

Fax referral form 8511 should be filled out with the patient's information, reason for referral, referring provider's information, and other relevant details regarding the referral.

What is the purpose of fax referral form 8511?

The purpose of fax referral form 8511 is to facilitate the communication and coordination of care between healthcare providers when referring a patient for further treatment or evaluation.

What information must be reported on fax referral form 8511?

Information such as patient's name, date of birth, medical history, reason for referral, referring provider's information, and contact details of the receiving provider must be reported on fax referral form 8511.

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