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#305, Hys Centre, 11010 101 Street NW Edmonton, AB T5H 4B9 Tel. (780) 4777575 Fax (780) 4744415 www.braincarecentre.comReferral for Brain Care Centre Concussion Service Program Completed referral
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How to fill out concussion services referral
How to fill out concussion services referral
01
Fill out patient's personal information including name, date of birth, and contact information
02
Provide details of the concussion including date of injury, symptoms, and any relevant medical history
03
Include information about the referring provider and their contact information
04
Specify any special instructions or requests for the referral
Who needs concussion services referral?
01
Individuals who have experienced a concussion and require specialized medical services
02
Patients who have been evaluated by a healthcare provider and deemed in need of further treatment for their concussion
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What is concussion services referral?
Concussion services referral is a formal process to direct individuals who have sustained a concussion to appropriate medical professionals or services that specialize in diagnosing and treating concussions.
Who is required to file concussion services referral?
Typically, health care providers, such as physicians or licensed healthcare professionals, are required to file concussion services referrals when they diagnose a concussion or suspect a concussion in a patient.
How to fill out concussion services referral?
To fill out a concussion services referral, the provider must provide patient information, details regarding the concussion incident, assessment findings, and recommendations for further evaluation or management.
What is the purpose of concussion services referral?
The purpose of the concussion services referral is to ensure that individuals receive appropriate care and support following a concussion, which is critical for recovery and management of symptoms.
What information must be reported on concussion services referral?
The concussion services referral must report the patient's name, date of birth, contact information, details about the concussion incident, medical history, assessment results, and any specific recommendations for treatment.
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