Get the free Colposcopy Program Referral Form - Royal Victoria Hospital

ROYAL VICTORIA REGIONAL HEALTH Center COLONOSCOPY PROGRAM NEW COLONOSCOPY PROGRAM at VH Now accepting all regional colonoscopy referrals All colonoscopy referrals to VH are to come through this route

How to fill out colposcopy program referral form

How to fill out colposcopy program referral form:

1. Start by gathering all the necessary information before filling out the form. This may include the patient's personal details, medical history, and any relevant test results.
2. Look for the section on the form that requires the patient's personal information. Fill in the patient's full name, address, contact number, and date of birth accurately.
3. Proceed to the medical history section. Provide details about the patient's previous medical conditions, surgeries, medications, and any allergies they may have. Make sure to include the date of diagnosis if applicable.
4. If the patient has undergone any previous colposcopy procedures, indicate the date, findings, and any recommendations or treatments that were provided.
5. Next, include any additional relevant test results that may support the need for a colposcopy. This can include Pap smear results, biopsy reports, or any abnormal findings.
6. Fill out the section that requires the healthcare provider's details. This usually includes the name, address, contact number, and medical license number. Provide accurate information to ensure proper communication between the referring provider and the colposcopy program.
7. If the referral form requires any patient consent or signature, ensure that the patient or their legal guardian signs and dates the appropriate sections.
8. Finally, review the completed form for any errors or missing information. Ensure that the form is filled out legibly and thoroughly.
9. Submit the completed referral form as per the designated process outlined by the colposcopy program.

Who needs colposcopy program referral form?

1. Women who have abnormal Pap smear results: If a woman's Pap smear indicates abnormal or inconclusive results, further evaluation with colposcopy is often required. The referral form helps facilitate this process for the patient and their healthcare provider.
2. Individuals with positive HPV test results: Human Papillomavirus (HPV) is a common infection that can lead to abnormal cervical cell changes. Those who test positive for high-risk types of HPV may need to undergo colposcopy for further assessment.
3. Patients with concerning symptoms: Women experiencing symptoms such as abnormal bleeding, pain during intercourse, or persistent pelvic pain may be referred for colposcopy to rule out any underlying issues.
4. Individuals with a history of cervical dysplasia: Patients who have previously been diagnosed with cervical dysplasia or precancerous cell changes may require regular colposcopy surveillance. The referral form ensures a smooth process for these patients.
5. Those needing evaluation post-treatment: If a patient has undergone treatment for cervical dysplasia or cervical cancer, colposcopy may be necessary to monitor the effects of the treatment and assess for any recurrence.
6. Patients referred by other healthcare providers: Obstetricians, gynecologists, family physicians, or other healthcare professionals may refer their patients for colposcopy if they suspect or identify any abnormal cervical findings that require further investigation.

In conclusion, filling out the colposcopy program referral form correctly and completely is essential for ensuring effective communication between the referring healthcare provider and the colposcopy program. This helps facilitate timely evaluation and appropriate management for women who may require further assessment of their cervical health.

For pdfFiller’s FAQs

How can I send colposcopy program referral form to be eSigned by others?

Once your colposcopy program referral form is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.

How can I edit colposcopy program referral form on a smartphone?

The easiest way to edit documents on a mobile device is using pdfFiller’s mobile-native apps for iOS and Android. You can download those from the Apple Store and Google Play, respectively. You can learn more about the apps here. Install and log in to the application to start editing colposcopy program referral form.

How do I complete colposcopy program referral form on an Android device?

Use the pdfFiller app for Android to finish your colposcopy program referral form. The application lets you do all the things you need to do with documents, like add, edit, and remove text, sign, annotate, and more. There is nothing else you need except your smartphone and an internet connection to do this.