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Cera (a division of Chealth) Suite 210, 1016 68 Avenue SW Calgary, AB T2V 4J2 Ph: (403) 5410033 Fx: (403) 5410032 www.chealth.ca www.chealth.caCERA CARDIOMETABOLIC EVALUATION & RISK ASSESSMENT REFERRAL
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How to fill out active-c-era-clinic-sw-referral-form-13dec2021-1pdf
How to fill out active-c-era-clinic-sw-referral-form-13dec2021-1pdf
01
Begin with the patient's personal information, including full name, date of birth, and contact details.
02
Fill in the referring physician's information, including name, address, and contact details.
03
Specify the reason for the referral, including any relevant medical history or symptoms.
04
Indicate any previous treatments or tests related to the patient's condition.
05
Complete any additional sections required for assessment, such as insurance or financial information.
06
Review the entire form for clarity and completeness before submission.
07
Sign and date the form where indicated.
Who needs active-c-era-clinic-sw-referral-form-13dec2021-1pdf?
01
Individuals seeking specialized medical care from the active CERA clinic.
02
Primary care physicians referring patients for further evaluation or treatment.
03
Patients who require documentation for insurance purposes.
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What is active-c-era-clinic-sw-referral-form-13dec2021-1pdf?
The active-c-era-clinic-sw-referral-form-13dec2021-1pdf is a referral form used in the healthcare sector to facilitate the referral of patients to specialized services or clinics.
Who is required to file active-c-era-clinic-sw-referral-form-13dec2021-1pdf?
Healthcare providers, such as doctors or clinics, are required to file the active-c-era-clinic-sw-referral-form-13dec2021-1pdf when referring patients to other specialized clinics.
How to fill out active-c-era-clinic-sw-referral-form-13dec2021-1pdf?
To fill out the form, provide the patient's personal information, the reason for referral, the services required, and any relevant medical history. Ensure all sections are completed accurately.
What is the purpose of active-c-era-clinic-sw-referral-form-13dec2021-1pdf?
The purpose of the form is to document and streamline the process of referring patients to additional medical services, ensuring that their needs are met effectively.
What information must be reported on active-c-era-clinic-sw-referral-form-13dec2021-1pdf?
The form must include patient identification details, referring provider's information, reason for referral, recommended services, and any pertinent medical history.
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