Get the free Adolescent Health Clinic Referral Form

Pediatric and Adolescent Gynecology Dr. Ellen Giesbrecht, Dr. Debra Miller, Dr. Amalia Scheming, Dr. Nicole ToddREFERRAL Formation will be contacted directly with appointment FAX REFERRAL TO: 604

How to fill out adolescent health clinic referral

How to fill out adolescent health clinic referral

1. To fill out an adolescent health clinic referral, follow these steps:
2. Obtain a referral form from the adolescent health clinic or download it from their website.
3. Fill out the referring healthcare provider's information, including name, address, phone number, and any other required details.
4. Provide the patient's personal information, such as name, date of birth, address, and contact number.
5. Specify the reason for the referral, including any relevant medical history or concerns.
6. Indicate the preferred appointment date and time, if applicable.
7. Include any additional information or instructions that may be necessary.
8. Double-check all the information provided to ensure accuracy.
9. Submit the completed referral form to the adolescent health clinic by mail, fax, or through their online referral portal, as specified.
10. Retain a copy of the referral form for your records.
11. Please note that specific instructions may vary depending on the clinic's requirements. It is recommended to contact the clinic for any further guidance.

Who needs adolescent health clinic referral?

1. Adolescent health clinic referrals are typically needed for individuals between the ages of 12 and 18, or up to 21 in some cases.
2. Those who may require an adolescent health clinic referral include:
3. - Adolescents seeking specialized healthcare services specific to their age group.
4. - Individuals requiring reproductive health services, such as contraception, STI testing, or pregnancy counseling.
5. - Adolescents with specific mental health concerns.
6. - Young people in need of addiction or substance abuse support.
7. - Teens with chronic health conditions that require ongoing care.
8. - Patients requiring confidential or private healthcare services.
9. It is best to consult with a healthcare provider to determine if an adolescent health clinic referral is necessary for a particular individual.

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What is adolescent health clinic referral?

An adolescent health clinic referral is a formal process through which healthcare providers direct adolescents to specialized health clinics that cater to the specific health needs of young people, typically addressing issues related to physical, mental, and emotional well-being.

Who is required to file adolescent health clinic referral?

Healthcare providers, particularly those working with adolescents, are typically responsible for filing adolescent health clinic referrals when they identify the need for specialized care for their young patients.

How to fill out adolescent health clinic referral?

To fill out an adolescent health clinic referral, providers should include patient information, the specific health concerns being referred, any relevant medical history, and the recommended specialist or clinic. It often involves completing a standardized form provided by the health system.

What is the purpose of adolescent health clinic referral?

The purpose of an adolescent health clinic referral is to ensure that young patients receive appropriate and specialized care, facilitating access to services that may not be available in general medical practice.

What information must be reported on adolescent health clinic referral?

Information that must be reported on an adolescent health clinic referral includes the patient's name, age, reason for referral, any pertinent medical history, and contact details of both the referring provider and the receiving clinic.