Get Ou Childrens Referral Form

Filling out the OU Children’s Referral Form online can streamline the process of requesting an appointment for children’s healthcare services. This guide provides step-by-step instructions to help users complete the form accurately and efficiently. Follow these guidelines to ensure a smooth referral process.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the OU Children’s Referral Form and open it in your preferred editor.
2. Enter today’s date at the top of the form to indicate when the referral is being submitted.
3. Fill in the patient's name, selecting M or F by circling the appropriate option, followed by the patient's date of birth in the designated area.
4. Provide the patient's Social Security Number (SSN) in the space allocated for it.
5. Complete the patient’s address, including city, state, and zip code in the respective fields.
6. Input the home phone number of the patient or their guardian.
7. List the names of the parent(s) or guardian(s) and their Social Security Numbers.
8. Record the primary and cell phone numbers of the parent(s) or guardian(s), along with their relationship to the child.
9. Include an additional emergency contact's name and their primary and secondary phone numbers.
10. Attach a front and back copy of the patient’s insurance card in the provided section.
11. Fill in the referral information, including the phone number and the name of the referring physician, as well as their office contact name.
12. Indicate the fax number for the referring physician’s office.
13. Select which OU Children’s Physician provider or clinic you are requesting an appointment with.
14. Clearly describe the diagnosis or reason for the visit in the designated space.
15. Mark the reason or intent for the visit by selecting either ‘Consult’ or ‘Transfer of care’ and completing any additional fields for a consultation request.
16. Print and sign the requesting provider’s name at the bottom of the form.
17. Ensure that all required fields are accurately completed, as indicated with an asterisk.
18. If applicable, indicate whether any attached referrals or medical records are included, using 'Y' for yes or 'N' for no.
19. Review the completed form for accuracy, and save changes as needed. You can download, print, or share the form as necessary.

Complete your documents online today to facilitate the appointment scheduling process!