Get the free Fetal-maternal Center Referral Form

This form is intended for referring physicians to request services from the Fetal-Maternal Center, including perinatology consultations, pediatric subspecialty services, and transfer of OB care. It

How to fill out fetal-maternal center referral form

How to fill out fetal-maternal center referral form

1. Begin by entering the patient's personal information, including name, age, and contact details.
2. Fill in the medical history section, noting any relevant past pregnancies, complications, or pre-existing conditions.
3. Provide details about the current pregnancy, including gestational age, expected delivery date, and any pertinent ultrasound findings.
4. Document any current health issues or symptoms the patient is experiencing.
5. Include the referring physician's information, ensuring to add their contact details for follow-up.
6. Check the form for completeness and accuracy before submission.

Who needs fetal-maternal center referral form?

1. Patients with high-risk pregnancies due to maternal health conditions, fetal abnormalities, or complications.
2. Women experiencing abnormal pregnancy symptoms or requiring specialized maternal-fetal care.
3. Referring healthcare providers who identify the need for specialized consultation or management of maternal and fetal health.

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What is fetal-maternal center referral form?

The fetal-maternal center referral form is a document used to refer pregnant patients to specialized care at fetal-maternal centers, which are equipped to handle high-risk pregnancies.

Who is required to file fetal-maternal center referral form?

Medical professionals, such as obstetricians or primary care physicians, are typically required to file the fetal-maternal center referral form for patients needing specialized care.

How to fill out fetal-maternal center referral form?

To fill out the fetal-maternal center referral form, provide patient demographics, medical history, details of the pregnancy, reason for referral, and any relevant test results.

What is the purpose of fetal-maternal center referral form?

The purpose of the fetal-maternal center referral form is to ensure that patients receive appropriate and timely care for high-risk pregnancies, facilitating communication between healthcare providers.

What information must be reported on fetal-maternal center referral form?

Information that must be reported includes patient identification, obstetric history, clinical findings, reasons for referral, and any pertinent laboratory or ultrasound results.