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Form used for referring patients to the Backus Center for Mental Health. It collects patient demographics, medical coverage, current diagnosis and medications, reason for referral, requested services, and contact information.
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What is external referral form?
An external referral form is a document used to refer a patient or client to an external service or specialist for further evaluation or treatment.
Who is required to file external referral form?
Typically, healthcare providers, such as physicians or clinicians, are required to file an external referral form when they need to send a patient to another provider or facility.
How to fill out external referral form?
To fill out an external referral form, include patient information, details of the referring provider, reason for referral, relevant medical history, and any required attachments or authorizations.
What is the purpose of external referral form?
The purpose of an external referral form is to facilitate communication between the referring provider and the receiving provider, ensuring that the patient receives appropriate care.
What information must be reported on external referral form?
The external referral form must report the patient's demographics, the reason for referral, medical history, specific services needed, and the referring physician's contact information.
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