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How to fill out the Epilepsy Monitoring Referral Form online
Completing the Epilepsy Monitoring Referral Form is a crucial step in securing appropriate care for individuals experiencing epilepsy. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently.
Follow the steps to fill out the form correctly
- Press the ‘Get Form’ button to access the Epilepsy Monitoring Referral Form and open it in your browser.
- Begin by entering the patient's name in the designated field. Ensure that the name is spelled correctly as it appears on legal documents.
- Input the patient's date of birth in the appropriate section. Use the format MM/DD/YYYY for clarity.
- Provide the primary contact number for the patient. Make sure this number is reachable for any follow-up questions or confirmations.
- If applicable, include an alternative contact number in the designated field. This can be helpful for additional communication.
- Indicate whether the patient is aware of the OSU EMU referral by marking the appropriate option: 'YES' or 'NO'.
- Select the reason for the EMU admission by circling one of the options provided: 'Diagnostic' or 'Treatment'. This helps determine the purpose of the referral.
- Fill in the diagnosis code(s) as required. Ensure that these codes are accurate to facilitate effective processing.
- For previous EEGs, indicate whether any were completed by selecting 'YES' or 'NO'. If yes, provide the dates and results of these tests in the spaces provided.
- After completing all sections of the form, be sure to review your entries for accuracy before you proceed. Once confirmed, you can choose to save changes, download, print, or share the completed form as needed.
Start filling out the Epilepsy Monitoring Referral Form online today to ensure timely medical attention for your needs.
To get checked for epilepsy, you should visit a healthcare provider who specializes in seizures. They will typically perform neurological exams, review your medical history, and may recommend tests like EEGs or MRIs. Using the Epilepsy Monitoring Referral Form can help provide essential information for a comprehensive evaluation.
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