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Chronic Kidney Disease Referral Form University of Arkansas for Medical Sciences/Arkansas Department of Health Patient Name: Address: Phone Number: EFR or Serum Cr Age Race Sex Cause of kidney disease:

How to fill out chronic kidney disease referral

How to fill out chronic kidney disease referral:

1. Start by obtaining the necessary referral form from your healthcare provider or clinic. This form is typically used to refer patients with suspected or known chronic kidney disease to a nephrologist or specialist.
2. Fill out the patient's personal information accurately. This includes their full name, date of birth, contact information, and medical record number (if applicable). Make sure to double-check the information to avoid any errors.
3. Provide a detailed medical history of the patient. This may include information about any pre-existing conditions, past surgeries, current medications, allergies, and family history of kidney disease. It is essential to provide as much relevant information as possible to assist the specialist in making an accurate diagnosis.
4. Specify the reason for the referral. Clearly state the symptoms or concerns that led to the suspicion of chronic kidney disease. This can include symptoms like frequent urination, blood in the urine, swelling, unexplained weight loss, or persistent high blood pressure. If there are any test results or imaging reports available, attach them to the referral form.
5. Indicate the desired urgency for the referral. Depending on the patient's condition and the severity of their symptoms, you may need to specify if the referral is routine or if it requires urgent attention. This helps in prioritizing referrals and ensuring timely access to necessary medical care.

Who needs chronic kidney disease referral:

1. Patients with specific symptoms: Those experiencing symptoms like persistent high blood pressure, frequent urination, blood in the urine, unexplained swelling, or unexplained weight loss should seek a referral for chronic kidney disease evaluation.
2. Individuals with pre-existing conditions: Patients with conditions that are known to increase the risk of chronic kidney disease, such as diabetes, hypertension, obesity, cardiovascular disease, or a family history of kidney disease, should consider getting a referral for further evaluation.
3. Persons with abnormal lab results: Individuals with abnormal findings in routine blood or urine tests, such as elevated creatinine levels, proteinuria, or abnormal kidney function tests, should consult with their healthcare provider about a referral for chronic kidney disease assessment.

Remember, it is always best to consult with a healthcare professional who can evaluate your specific situation and determine the need for a chronic kidney disease referral.

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What is chronic kidney disease referral?

Chronic kidney disease referral is a process where patients with kidney disease are referred to specialists for further evaluation and treatment.

Who is required to file chronic kidney disease referral?

Healthcare providers such as primary care physicians, nephrologists, and other specialists are required to file chronic kidney disease referral.

How to fill out chronic kidney disease referral?

To fill out chronic kidney disease referral, healthcare providers must include the patient's medical history, lab results, and reason for referral.

What is the purpose of chronic kidney disease referral?

The purpose of chronic kidney disease referral is to ensure that patients with kidney disease receive specialized care and treatment.

What information must be reported on chronic kidney disease referral?

Chronic kidney disease referral must include patient demographics, medical history, current medications, lab results, and reason for referral.