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SBS Referral/Consultation Request Formulas complete this form and fax to: (718) 6903391For questions, call (718) 9609122 or email cpro@sbhny.orgDate of Request: ___/___/___Patient InformationPatient
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How to fill out sbh referralconsultation request form

01
Obtain the SBH referral/consultation request form from the healthcare provider or facility.
02
Fill out the patient's personal information including name, date of birth, contact information, and insurance details.
03
Provide the reason for the referral/consultation and any relevant medical history or test results.
04
Specify the preferred specialist or department for the referral/consultation.
05
Ensure all sections of the form are completed accurately and legibly.
06
Submit the completed form to the designated contact or department as instructed.

Who needs sbh referralconsultation request form?

01
Patients who require a referral to a specialist or department at SBH.
02
Healthcare providers referring patients for specialized care at SBH.
03
Facilities requesting consultations or services from SBH.

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The SBH Referral Consultation Request Form is a formal document used to request a referral for consultation services within the health system.
Healthcare providers who need to refer patients for specialized consultation services are required to file the SBH Referral Consultation Request Form.
To fill out the SBH Referral Consultation Request Form, provide patient information, the reason for the referral, and any necessary medical history or documentation as required by the form.
The purpose of the SBH Referral Consultation Request Form is to ensure effective communication between healthcare providers when referring patients for specialized care.
The form must report patient demographics, the referring provider's information, the reason for the referral, medical history, and any pertinent notes for the consulting provider.
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