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How to fill out the Uic Referral Form online
The Uic Referral Form is a key document for referring patients to the University of Illinois at Chicago College of Dentistry for oral and maxillofacial surgery. This guide offers clear, step-by-step instructions to assist users in completing the form online easily and effectively.
Follow the steps to successfully complete the Uic Referral Form
- Click ‘Get Form’ button to obtain the form and open it in a digital editor.
- Enter the date of referral in the designated field at the top of the form.
- Provide your name as the referring practitioner, along with your office phone number, email, and fax information.
- Fill in the patient’s name or parent’s name if the patient is a minor, and provide their contact information, including phone and email.
- Detail the patient's insurance information in the relevant section.
- Indicate the required dentoalveolar surgery, marking the relevant checkboxes and providing specific tooth numbers when necessary.
- If needed, specify any additional procedures such as alveoplasty, incision and drainage, or biopsy, amongst others.
- Include any dental implant numbers or pathology details in the provided fields.
- For orthognathic evaluation and TMJ evaluation, briefly describe the requirements.
- Identify whether radiographs are attached, to be sent by email or mail, or indicate if none are available.
- Provide information regarding the patient's medical history, noting if it is negative or detailing any significant issues or special needs.
- Choose anesthesia recommendations appropriate for the procedure.
- Complete any other comments or additional instructions in the provided space.
- Finally, enter your name, signature or initials, phone, fax, and email as the person completing the form.
- Review the entire form for accuracy and completeness, then proceed to save changes, download, print, or share the form as necessary.
Complete the Uic Referral Form online and ensure you provide all necessary details for a smooth referral process.
Becoming a patient at UIC Dental School involves a few straightforward steps. First, you will need to obtain a referral from your dentist or healthcare provider and complete the necessary UIC Referral Form. Once the form is submitted and reviewed, the school will contact you to discuss available services and schedule your appointment. Embracing this process allows you to access quality dental care at UIC.
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