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This form is used for surgical requisitions at The Children’s Hospital of Philadelphia. It includes sections for patient information, provider information, specimen details, and billing information

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How to fill out consult surgical requisition

01

Obtain the consult surgical requisition form from the medical office or hospital.

02

Fill in the patient's personal information including name, date of birth, and contact information.

03

Provide a detailed medical history relevant to the surgical procedure.

04

Indicate the specific surgical procedure being requested.

05

Include any relevant diagnostic information, such as lab results or imaging studies.

06

Specify the urgency of the consult, if applicable.

07

Sign and date the requisition form.

08

Submit the completed form to the appropriate surgical department or specialist.

Who needs consult surgical requisition?

01

Patients who require a surgical procedure and need a referral.

02

Primary care physicians or specialists seeking surgical intervention for their patients.

03

Healthcare providers coordinating care for patients needing surgery.

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What is consult surgical requisition?

A consult surgical requisition is a formal request for a surgical consultation, initiated by a medical professional to evaluate a patient's need for surgery or further assessment.

Who is required to file consult surgical requisition?

Typically, the primary care physician or a specialist who believes a patient requires surgical evaluation must file the consult surgical requisition.

How to fill out consult surgical requisition?

To fill out a consult surgical requisition, the submitting physician should complete patient identification details, the reason for consultation, relevant medical history, and any pertinent examination findings.

What is the purpose of consult surgical requisition?

The purpose of a consult surgical requisition is to formally communicate the need for a surgical assessment and to provide the necessary information to the consulting surgeon for appropriate evaluation.

What information must be reported on consult surgical requisition?

The consult surgical requisition must include patient demographics, medical history, current medications, reason for the surgical consult, relevant physical exam findings, and any previous tests or imaging studies related to the case.

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