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Breast Diagnostic Clinic (BDC) REFERRAL FORM FORM SF0075Page 1 of 1Patient LABEL / Identification AreaRev. 11/2024 02/2019All reports MUST be attached to referral for appointment to be made, including:Diagnostic
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How to fill out breast assessment referral form
How to fill out breast assessment referral form
01
Begin by entering the patient's personal information, including name, date of birth, and contact details.
02
Fill in the referring physician's information, including name, contact number, and facility.
03
Specify the reason for the referral in the designated section, providing relevant medical history and symptoms.
04
Indicate the type of breast assessment required (e.g., ultrasound, mammogram, biopsy).
05
Attach any necessary medical records or previous imaging results to support the referral.
06
Review the form for completeness and accuracy before submission.
07
Submit the form to the appropriate department or clinic as per the facility's protocol.
Who needs breast assessment referral form?
01
Patients who are experiencing breast symptoms such as lumps, pain, or unusual changes in breast tissue.
02
Individuals with a family history of breast cancer or genetic predispositions.
03
Patients who require follow-up assessments after a previous diagnosis or treatment.
04
Individuals who need routine screenings based on age or risk factors as advised by their healthcare provider.
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What is breast assessment referral form?
The breast assessment referral form is a document used by healthcare providers to refer patients for further evaluation of breast-related issues, typically to a specialist, for diagnostic procedures or assessments.
Who is required to file breast assessment referral form?
Healthcare providers, such as primary care physicians or gynecologists, are required to file the breast assessment referral form when they identify a need for further evaluation of a patient's breast health.
How to fill out breast assessment referral form?
To fill out the breast assessment referral form, the healthcare provider must complete sections detailing the patient's demographic information, the reason for referral, clinical findings, diagnostic history, and any relevant medical history.
What is the purpose of breast assessment referral form?
The purpose of the breast assessment referral form is to ensure proper documentation and facilitate communication between healthcare providers, ultimately aiding in the timely and effective evaluation and management of breast health issues.
What information must be reported on breast assessment referral form?
The information that must be reported on the breast assessment referral form includes the patient's name, contact information, referring provider's details, reason for referral, clinical findings, imaging results, and any significant medical or family history related to breast health.
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