Get the free Butler Hospital Referral Form OCD & Anxiety Intensive Outpatient ...

Butler Hospital Referral Form OCD & Anxiety Intensive Outpatient Program Butler Hospital Intake Department Contact Information: Phone: (844) 4010111Fax: (401) 4556481The OCD and Anxiety Disorders

How to fill out butler hospital referral form

How to fill out butler hospital referral form

1. Obtain a copy of the Butler Hospital referral form.
2. Fill out all personal information requested on the form, including name, date of birth, address, and contact information.
3. Provide information about referring provider, including name, contact information, and reason for referral.
4. Include any relevant medical history, current medications, and reason for seeking services at Butler Hospital.
5. Sign and date the form, acknowledging that the information provided is accurate.
6. Submit the completed form to Butler Hospital either in person or by fax, as instructed.

Who needs butler hospital referral form?

1. Individuals who have been referred to Butler Hospital for mental health or addiction treatment services.
2. Healthcare providers who are referring a patient to Butler Hospital for specialized care or evaluation.

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What is butler hospital referral form?

The Butler Hospital referral form is a document used to request a referral to the hospital for medical treatment or mental health services.

Who is required to file butler hospital referral form?

Any individual or healthcare provider who wishes to refer a patient to Butler Hospital is required to file the referral form.

How to fill out butler hospital referral form?

To fill out the Butler Hospital referral form, you will need to provide the patient's personal information, medical history, reason for referral, and any other relevant details.

What is the purpose of butler hospital referral form?

The purpose of the Butler Hospital referral form is to facilitate the process of referring patients to the hospital for specialized medical or mental health care.

What information must be reported on butler hospital referral form?

The Butler Hospital referral form must include the patient's name, contact information, medical history, reason for referral, referring healthcare provider's information, and any relevant supporting documents.