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Referring Provider Referral Form PHONE: (360) 2546161, option 1 FAX: (360) 8030054www.rebounded.complete complete the section below with as much information as possible and fax this form to (360)

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How to fill out referring provider referral form

01

Obtain the referring provider referral form from the appropriate source

02

Fill out the patient's information including name, date of birth, and contact information

03

Provide details of the referral reason and any specific instructions or requests

04

Complete the referring provider information section accurately

05

Review the form for any errors or missing information before submitting

Who needs referring provider referral form?

01

Patients who are being referred to another provider for further evaluation or treatment

02

Healthcare providers who are referring their patients to specialists or other healthcare professionals

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What is referring provider referral form?

The referring provider referral form is a document used to refer a patient from one healthcare provider to another, ensuring appropriate communication and information transfer regarding the patient's care.

Who is required to file referring provider referral form?

Healthcare providers who refer patients to specialists or other healthcare services are required to file a referring provider referral form.

How to fill out referring provider referral form?

To fill out the referring provider referral form, you need to provide the patient's basic information, the referring provider's details, the reason for referral, and any relevant medical history or notes.

What is the purpose of referring provider referral form?

The purpose of the referring provider referral form is to facilitate patient care by providing necessary information to the receiving provider, ensuring continuity and coordination in treatment.

What information must be reported on referring provider referral form?

The form must include details such as the patient's name, contact information, insurance details, the referring provider's information, the reason for the referral, and any pertinent medical history.

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