Get the free Occupational Therapy Referral (Fax Form) Low... - ot wustl

Occupational Therapy Referral (Fax Form) Low Vision Community Practice FAX # 286-1601 TO: Washington University, Program in Occupational Therapy, Attention: S. Cross white FROM: (name) (fax) (phone)

How to fill out occupational therapy referral fax

How to fill out occupational therapy referral fax:

1. Obtain the necessary referral form from your healthcare provider or occupational therapy clinic.
2. Fill in your personal information accurately, including your full name, date of birth, address, and contact information.
3. Provide information about your healthcare provider or referring physician, including their name, address, and contact details.
4. Include details about your medical condition or reason for seeking occupational therapy, providing as much information as possible to assist in the evaluation and treatment process.
5. Indicate any current medications you are taking, including the dosage and frequency.
6. Ensure that you have attached any relevant medical records or test results that may support your request for occupational therapy.
7. Sign and date the referral form, indicating your consent for the referral and release of information.
8. Make a copy of the completed referral form for your records before sending it via fax to the designated recipient.

Who needs occupational therapy referral fax:

1. Individuals who have been referred by their healthcare provider for occupational therapy services.
2. Patients seeking specialized care to improve their daily functioning, independence, and quality of life.
3. People with various medical conditions, injuries, or disabilities that may benefit from the expertise of occupational therapists, such as stroke survivors, individuals with neurological disorders, or those recovering from surgeries or accidents.

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What is occupational therapy referral fax?

Occupational therapy referral fax is a document sent by a healthcare provider to refer a patient to an occupational therapist for evaluation and treatment.

Who is required to file occupational therapy referral fax?

Healthcare providers such as physicians, nurse practitioners, and physician assistants are required to file occupational therapy referral fax.

How to fill out occupational therapy referral fax?

Occupational therapy referral fax should include the patient's demographic information, medical history, reason for referral, and any relevant medical records.

What is the purpose of occupational therapy referral fax?

The purpose of occupational therapy referral fax is to facilitate communication between healthcare providers and ensure appropriate referral for occupational therapy services.

What information must be reported on occupational therapy referral fax?

Information such as patient demographics, medical history, reason for referral, and relevant medical records must be reported on occupational therapy referral fax.