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Patient Name: DOB: MAN: Pain Consultation and Treatment Center Phone: (505) 9254431 Fax: (505) 9257679 External Referral / Consult Request Form Instruction: The following information will be required
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How to fill out a referral for UNM Hospitals:

01
Gather the patient's information, including their full name, date of birth, contact information, and insurance details.
02
Obtain the referring provider's information, such as their name, contact information, and specialty.
03
Identify the reason for the referral and provide a detailed description of the patient's condition or medical history that necessitates the referral to UNM Hospitals.
04
Indicate the specific department or specialty at UNM Hospitals where the referral should be directed.
05
Ensure all necessary supporting documentation, such as medical records, test results, and imaging reports, are included with the referral.
06
Double-check that the referral form is complete and accurate before submitting it to UNM Hospitals.

Who needs a referral for UNM Hospitals:

01
Patients who have been evaluated by their primary care physician or a specialist and require specialized care or treatment available at UNM Hospitals.
02
Individuals whose insurance plan requires a referral for certain medical procedures or consultations.
03
Patients seeking a second opinion or access to specialized medical expertise or advanced treatment options available exclusively at UNM Hospitals.
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Referral at UNM Hospitals is a process through which patients are directed to a specialist or another facility for further treatment or assessment.
Referrals at UNM Hospitals are typically filed by the primary care physician or the treating physician.
To fill out a referral at UNM Hospitals, the referring physician must complete a referral form with the patient's information and reason for referral.
The purpose of a referral at UNM Hospitals is to ensure that patients receive the necessary specialized care or services that their primary care physician may not provide.
The referral form at UNM Hospitals typically requires the patient's personal information, medical history, reason for referral, and the specialist or facility the patient is being referred to.
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