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Oncology PET/CT REFERRAL DATA SHEET
Please note new
location and
contact information
for Epicenter for Molecular Imaging and Therapy
2120 Kings Highway
Scheduling: 3187164001
Fax: 3187164075PATIENT
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How to fill out refer a patient for
How to fill out refer a patient for
01
Obtain the necessary information about the patient including name, contact information, medical history, and reason for referral.
02
Contact the healthcare provider or facility where the patient will be referred to inquire about their referral process.
03
Fill out the referral form provided by the healthcare provider or facility, making sure to include all required information accurately.
04
Submit the referral form through the appropriate channels, which may include fax, email, or online submission.
05
Follow up with the healthcare provider or facility to ensure that the referral was received and to coordinate any additional steps needed for the patient's care.
Who needs refer a patient for?
01
Healthcare professionals such as doctors, nurses, and other healthcare providers may need to refer a patient to another provider or facility for specialized care or treatment.
02
Patients who require specialized care or treatment that is not available at their current healthcare provider may also need to be referred to another provider or facility.
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What is refer a patient for?
Refer a patient for is a form used to document the transfer of a patient's care from one healthcare provider to another.
Who is required to file refer a patient for?
Healthcare providers who are transferring a patient's care or specialists receiving the patient are typically required to file refer a patient for.
How to fill out refer a patient for?
To fill out refer a patient for, include the patient's personal information, details of the current healthcare provider, the reason for referral, and the new provider's information.
What is the purpose of refer a patient for?
The purpose of refer a patient for is to ensure continuity of care for the patient by providing essential information to the new healthcare provider.
What information must be reported on refer a patient for?
Information that must be reported includes patient demographics, medical history, current treatments, and the reason for the referral.
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