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1601 E Bell Road A13 Corner of 16th St. & Bell Rd Phoenix, AZ 85022 Phone: 4808633368 .com www.kidsdentalspot.comPEDIATRIC DENTAL SPECIALISTS Referral Form Please Fax this Form to Dr. David Jourabchi:
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How to fill out referral form to peds
How to fill out referral form to peds
01
Obtain a referral form from the pediatrician's office or hospital.
02
Fill out the patient's basic information such as name, date of birth, and contact information.
03
Provide details of the reason for the referral, including any relevant medical history or symptoms.
04
Include the referring physician's information and signature.
05
Submit the completed referral form to the pediatrician's office or hospital either in person or by fax.
Who needs referral form to peds?
01
Patients who require specialized pediatric care or consultation from a pediatrician may need a referral form to peds.
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What is referral form to peds?
The referral form to peds is a document used to refer a patient to a pediatric specialist for evaluation or treatment.
Who is required to file referral form to peds?
Healthcare providers, such as pediatricians or family doctors, are required to file the referral form to peds when they refer a patient to a pediatric specialty.
How to fill out referral form to peds?
To fill out the referral form to peds, provide patient information, reasons for referral, relevant medical history, and any specific specialist requirements.
What is the purpose of referral form to peds?
The purpose of the referral form to peds is to ensure that patients receive the appropriate specialty care based on their medical needs.
What information must be reported on referral form to peds?
The information that must be reported includes patient's personal details, medical history, reason for referral, and any other pertinent details that may assist the specialist.
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