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Wound Healing and Hyperbaric Oxygen Center at
Dignity Health Chandler Regional Medical Center
Referral Form
Patient Name: ___
DOB: ___
Phone: ___Chandler Wound Healing and Hyperbaric
Oxygen Center
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How to fill out wound care physicians referral
How to fill out wound care physicians referral
01
Obtain the necessary information about the patient's wound, including the type, size, and location.
02
Contact the wound care physician's office to request a referral form.
03
Fill out the referral form completely and accurately, including the patient's personal information and medical history.
04
Provide any additional documentation or test results related to the wound, if available.
05
Submit the completed referral form to the wound care physician's office either in person, by fax, or through secure online portal.
Who needs wound care physicians referral?
01
Patients with chronic wounds that are not healing properly.
02
Patients with wounds that are at risk of infection or other complications.
03
Patients with wounds that require specialized treatment and care.
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What is wound care physicians referral?
Wound care physicians referral is a document that is filled out by a healthcare provider to refer a patient to a wound care specialist for specialized treatment and care.
Who is required to file wound care physicians referral?
Healthcare providers including doctors, nurse practitioners, and physician assistants are required to file wound care physicians referral when necessary for their patients.
How to fill out wound care physicians referral?
To fill out a wound care physicians referral, the healthcare provider must include the patient's personal information, medical history, current wound condition, and reason for the referral to the wound care specialist.
What is the purpose of wound care physicians referral?
The purpose of wound care physicians referral is to ensure that patients with complex or chronic wounds receive the necessary specialized care and treatment from a wound care specialist.
What information must be reported on wound care physicians referral?
The information reported on a wound care physicians referral includes patient's personal information, medical history, current wound condition, and reason for the referral.
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