Get Ohcwa Referral Form 2020-2025

Completing the Ohcwa Referral Form online is a straightforward process that helps facilitate efficient referrals. This guide will provide you with clear, step-by-step instructions to ensure that all necessary information is accurately submitted.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Identify the section labeled 'Referred from' and select the appropriate referral source by checking the corresponding box. If your source is not listed, indicate 'Other' and specify.
3. Fill out the 'Referring Dentist' section with the name of the dentist making the referral and their registration number.
4. Enter the patient's information by providing their surname and given name in the 'Patient Name' section.
5. Input the patient’s date of birth in the designated field, followed by their address details.
6. Provide a telephone number and mobile number, including the postal code for the patient's address.
7. In the 'Referred for' section, check the box corresponding to the reason for the referral, such as endodontics or orthodontics, among others.
8. Indicate the urgency of the referral by selecting either 'High,' 'Medium,' or 'Waiting List.'
9. Detail any relevant medical history in the space provided to enhance the referral information.
10. If the referral includes oral surgery for the patient's wisdom teeth, fill out the number of teeth involved and whether they are impacted.
11. Specify if a general anesthetic is required for the procedure by checking 'Yes,' 'No,' or 'Unsure' and providing additional information as necessary.
12. The referring dentist must sign and date the form in the designated fields.
13. Finally, ensure that copies of relevant x-rays, patient eligibility forms, and any additional medical documents are attached before submitting the form.

Complete your Ohcwa Referral Form online today for a seamless referral process.