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317 Western Boulevard Jacksonville, NC 28546 Phone: 910.577.4900 Fax: 910.577.4910 OnslowRadiationOncology.orgNEW PATIENT REFERRAL DATE: ___ NAME: ___ DOB: ___ SS#: ___ SEX: ___ MARITAL STATUS: ___
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How to fill out new patient referral
How to fill out new patient referral
01
Obtain a new patient referral form from the clinic or healthcare provider.
02
Fill out all the required fields on the form including patient's name, contact information, reason for referral, and any relevant medical history.
03
Make sure to provide any necessary supporting documentation such as previous medical records or test results.
04
Double check the completed form for accuracy and completeness before submitting it to the appropriate healthcare provider or clinic.
Who needs new patient referral?
01
Anyone who is seeking medical care from a new healthcare provider or clinic may need to fill out a new patient referral form.
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What is new patient referral?
New patient referral is a process by which a healthcare provider refers a new patient to another healthcare provider or facility for further evaluation or treatment.
Who is required to file new patient referral?
Healthcare providers, such as doctors or specialists, are required to file new patient referral when they believe a patient would benefit from seeing another provider or facility.
How to fill out new patient referral?
To fill out a new patient referral, the referring provider must include the patient's information, reason for referral, any relevant medical history, and contact information for the receiving provider.
What is the purpose of new patient referral?
The purpose of new patient referral is to ensure that patients receive the appropriate care from the most qualified healthcare provider or facility for their condition.
What information must be reported on new patient referral?
The new patient referral must include the patient's demographics, medical history, reason for referral, current medications, relevant test results, and any other pertinent information.
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