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PLEASE FAX REFERRALS TO:6314656533 Questions? Please contact: GSH INTAKE TEAM6314656363 Patients Name: ___ Address: ___ City: ___Zip:___ Patients Phone: ___ Date of Birth: ___ Gender: Male Female
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How to fill out please fax referrals to

01
Obtain the necessary referral form from your healthcare provider.
02
Fill in the patient's personal information, including name, date of birth, and contact details.
03
Include the specific details of the referral, such as the specialist’s name and contact information.
04
Provide any relevant medical history or notes that the specialist may need.
05
Review the form for accuracy and completeness.
06
Send the completed form to the designated fax number provided by the specialist or healthcare facility.

Who needs please fax referrals to?

01
Patients requiring specialized medical care that necessitates a referral.
02
Healthcare providers who need to send patient referrals to specialists.
03
Administrative staff in healthcare settings responsible for processing referrals.
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Please fax referrals to the designated department or provider as specified by your organization's guidelines.
Healthcare providers or administrative staff are typically required to file referrals as per the organization's procedures.
To fill out please fax referrals, complete all required fields such as patient information, referring provider details, and the reason for referral.
The purpose of please fax referrals is to facilitate communication between healthcare providers for patient care and to ensure timely access to specialized services.
Information that must be reported includes patient demographics, referring physician details, the reason for the referral, and any pertinent medical history.
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