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STROKE AND TIA REFERRAL FORM PLEASE INDICATE BELOW WHICH STROKE MEDICINE SERVICE YOU WISH TO ACCESSHIGH RISK TIA (Event occurred 1 week) LOWER RISK TIA (Event occurred 1 week ago) Transient Ischaemic
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How to fill out stroke-prevention-clinic-referral-formpdf

01
Obtain a copy of the stroke-prevention-clinic-referral-form.pdf
02
Fill in patient information such as name, date of birth, and contact information
03
Provide details about medical history and any previous strokes or related conditions
04
Include information about current medications being taken
05
Indicate reason for referral to the stroke prevention clinic
06
Obtain necessary signatures from the referring healthcare provider
07
Submit the completed form to the appropriate clinic or healthcare facility

Who needs stroke-prevention-clinic-referral-formpdf?

01
Patients who have experienced a stroke or are at risk of having a stroke
02
Healthcare providers who are referring patients to a stroke prevention clinic

What is Stroke-Prevention-Clinic-Referral-.pdf Form?

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The stroke-prevention-clinic-referral-formpdf is a document used by healthcare providers to refer patients to a stroke prevention clinic.
Healthcare providers, such as physicians or nurse practitioners, are required to file the stroke-prevention-clinic-referral-formpdf for patients they believe are at risk of stroke.
To fill out the form, the provider must enter patient information, medical history, risk factors for stroke, and any relevant diagnostic tests or treatments.
The purpose of the form is to facilitate the referral process to stroke prevention clinics and ensure that at-risk patients receive timely intervention.
Information that must be reported includes patient demographics, medical history, risk factor assessment, and details of previous strokes or transient ischemic attacks.
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