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HUME WHITTLE SEA CATCHMENT DIABETES REFERRAL FORM Referring To: Addressee:Full Details Date of referral: Miscellaneous:Date (long) Northern Health Fax: 9467 8698 Phones: 9495 3443 Daniella Community
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How to fill out hard copy MD eReferral:

01
Obtain the hard copy MD eReferral form from the appropriate source, such as your healthcare provider or the official website.
02
Fill out the patient information section accurately, including the patient's full name, date of birth, contact information, and any other required details.
03
Provide the referring provider's information, such as their name, contact details, and medical practice information.
04
Specify the reason for the referral in detail, outlining the patient's symptoms, medical history, and any relevant test results or diagnoses. Be as specific as possible to ensure a thorough understanding of the patient's condition.
05
Indicate the preferred specialist or healthcare facility for the referral, including their name, contact details, and any necessary documentation or attachments.
06
Complete any additional sections or fields that are required, such as insurance information, referral authorization from insurance providers, or any other pertinent details.

Who needs hard copy MD eReferral:

01
Patients who require specialized care or treatment beyond the scope of their primary care provider may need a hard copy MD eReferral. This referral allows the patient to see a specialist or visit a specific healthcare facility that can address their specific medical needs.
02
Healthcare providers may also require a hard copy MD eReferral to refer their patients to other specialists or facilities for further evaluation, tests, treatments, or procedures that are not available within their own practice.
03
Additionally, insurance companies or third-party payers may require a hard copy MD eReferral as part of the authorization process for coverage of certain medical services or treatments. This ensures proper documentation and justification for the referral process.
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