Get the free New Patient Referral Fax Form

This document is a referral form to be faxed to KSC — General Internal Medicine for new patient referrals. It includes patient information, clinical indication/history, sub-specialty options, additional patient information, current or past diagnoses, current medications/treatments, and a section for attaching relevant information such as imaging reports and lab reports.

How to fill out new patient referral fax

How to fill out new patient referral fax

1. Start by gathering all necessary information about the patient including their name, date of birth, contact information, insurance details, and reason for referral.
2. Obtain the referring provider's information such as their name, contact details, and NPI number.
3. Fill out the referral form accurately and completely, ensuring all required fields are filled out.
4. Include any supporting documentation or medical records that may be necessary for the referral.
5. Double-check all information for accuracy before sending the fax to the receiving provider.

Who needs new patient referral fax?

1. Healthcare providers who are referring a new patient to another provider or specialist.
2. Patients who are seeking care from a new healthcare provider and have been referred by their current provider.

For pdfFiller’s FAQs

How can I send new patient referral fax for eSignature?

When your new patient referral fax is finished, send it to recipients securely and gather eSignatures with pdfFiller. You may email, text, fax, mail, or notarize a PDF straight from your account. Create an account today to test it.

How do I edit new patient referral fax online?

With pdfFiller, it's easy to make changes. Open your new patient referral fax in the editor, which is very easy to use and understand. When you go there, you'll be able to black out and change text, write and erase, add images, draw lines, arrows, and more. You can also add sticky notes and text boxes.

How do I edit new patient referral fax on an Android device?

You can. With the pdfFiller Android app, you can edit, sign, and distribute new patient referral fax from anywhere with an internet connection. Take use of the app's mobile capabilities.

What is new patient referral fax?

A new patient referral fax is a document sent via fax to refer a patient to a specialist or healthcare provider for further evaluation and treatment.

Who is required to file new patient referral fax?

Healthcare providers, such as primary care physicians, are typically required to file a new patient referral fax when referring patients to specialists.

How to fill out new patient referral fax?

To fill out a new patient referral fax, you should include the patient's demographic information, referring provider's details, reason for referral, relevant medical history, and any required attachments.

What is the purpose of new patient referral fax?

The purpose of a new patient referral fax is to communicate essential patient information between healthcare providers, ensuring a smooth transition of care.

What information must be reported on new patient referral fax?

The information that must be reported includes patient name, date of birth, insurance information, reason for referral, medical history, and any pertinent test results.