Get the free 0714.013 ELLIS-Refferal - Referral Form
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Phone 7062080451
fax 7062089147
www.ellispain.com1500 Langford Drive
Building 200
Watkinsville, Georgia 30677Mark Ellis, M.D. Jeremy Bagge, PAC Courtney Hinson, NPC
Amber Johnson, NPC Gentry Tolbert,
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How to fill out 0714013 ellis-refferal - referral
How to fill out 0714013 ellis-refferal - referral
01
Obtain the 0714013 Ellis Referral form from the appropriate source.
02
Fill out the patient's personal information, including name, date of birth, and contact information.
03
Provide details of the reason for the referral and any relevant medical history.
04
Include any supporting documentation or reports that may be helpful for the referral process.
05
Submit the completed form to the appropriate referral contact or office.
Who needs 0714013 ellis-refferal - referral?
01
Individuals who require specialized care or treatment that is not available within their current healthcare provider network may need to fill out the 0714013 Ellis Referral form.
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What is 0714013 ellis-refferal - referral?
0714013 ellis-referral is a document used for referring patients to specialists or other healthcare providers within a healthcare system.
Who is required to file 0714013 ellis-refferal - referral?
Healthcare providers, including primary care physicians and specialists, are required to file the 0714013 ellis-referral for their patients when a referral to another provider is necessary.
How to fill out 0714013 ellis-refferal - referral?
To fill out the 0714013 ellis-referral, healthcare providers must provide patient information, the reason for the referral, the specialist's contact information, and other relevant medical details.
What is the purpose of 0714013 ellis-refferal - referral?
The purpose of the 0714013 ellis-referral is to ensure that patients receive the appropriate care from specialists and to facilitate communication between different healthcare providers.
What information must be reported on 0714013 ellis-refferal - referral?
Information that must be reported includes patient demographics, referral reason, medical history, test results, and the referring provider's details.
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