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COMA LINDA UNIVERSITY CHILDREN HOSPITALMaternal Fetal Medicine Referral Form Patient Information Name___ DOB___ Age___ Address___ Phone number___ Cell Homework Insurance Information (Please fill in

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How to fill out maternal fetal medicine referral

01

Obtain the necessary information of the patient including medical history, previous pregnancies, and any current or past medical conditions.

02

Complete the referral form with accurate and detailed information about the patient's condition and the reason for the referral.

03

Attach any relevant medical records, test results, or imaging studies that may assist the maternal fetal medicine specialist in providing care.

04

Fax or electronically submit the referral form and supporting documentation to the maternal fetal medicine department.

05

Follow up with the patient to ensure they have received the necessary appointment details and any further instructions from the specialist.

Who needs maternal fetal medicine referral?

01

Pregnant women with high-risk pregnancies due to maternal medical conditions such as diabetes, hypertension, or autoimmune disorders.

02

Women with a history of complicated pregnancies or fetal abnormalities in previous pregnancies.

03

Patients with suspected or confirmed fetal anomalies on ultrasound or genetic testing.

04

Women carrying multiple pregnancies (twins, triplets, etc.)

05

Pregnant women over the age of 35 who may be at increased risk for chromosomal abnormalities in the fetus.

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What is maternal fetal medicine referral?

Maternal fetal medicine referral is a process where pregnant women with high-risk pregnancies are referred to a specialist for advanced care and monitoring.

Who is required to file maternal fetal medicine referral?

Maternal fetal medicine referral is typically filed by the healthcare provider overseeing the pregnancy, such as an obstetrician or midwife.

How to fill out maternal fetal medicine referral?

Maternal fetal medicine referral can be filled out by providing the patient's medical history, current pregnancy information, and reason for the referral.

What is the purpose of maternal fetal medicine referral?

The purpose of maternal fetal medicine referral is to ensure that pregnant women with high-risk pregnancies receive specialized care to improve maternal and fetal outcomes.

What information must be reported on maternal fetal medicine referral?

Information such as the patient's medical history, current pregnancy status, reason for referral, and any relevant test results must be reported on maternal fetal medicine referral.

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