Get the free Referral Form: UPMC Lung Transplant Program
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Pulmonary Referral Form Fax completed form to: 8339081122ancompanyancompanyPATIENT INFORMATION Patient Name: Address: Home Phone: Secondary Contact: Patient Diagnosis & ICD10: Allergies:Date of Birth:Physician
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How to fill out referral form upmc lung
How to fill out referral form upmc lung
01
Obtain the referral form upmc lung from your primary care physician or specialist.
02
Provide your personal information such as name, address, phone number, and date of birth on the form.
03
Provide the reason for the referral and any relevant medical history.
04
Include any supporting documentation such as test results or imaging reports.
05
Submit the completed referral form to the UPMC lung clinic either in person or through fax or email.
Who needs referral form upmc lung?
01
Patients who have been advised by their primary care physician or specialist to seek evaluation or treatment for lung-related conditions at UPMC.
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What is referral form upmc lung?
The referral form upmc lung is a document used to refer patients to the UPMC Lung Cancer Center for evaluation and treatment of lung-related conditions.
Who is required to file referral form upmc lung?
Any healthcare provider including physicians, nurses, or other medical professionals can file the referral form upmc lung on behalf of their patients.
How to fill out referral form upmc lung?
The referral form upmc lung can be filled out online through the UPMC website or by contacting the UPMC Lung Cancer Center directly.
What is the purpose of referral form upmc lung?
The purpose of the referral form upmc lung is to facilitate the referral process and ensure that patients receive timely and appropriate care for their lung conditions.
What information must be reported on referral form upmc lung?
The referral form upmc lung must include the patient's demographics, medical history, symptoms, and any relevant test results.
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