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Filling out the Dodd Hall inpatient rehabilitation referral form can be straightforward if you follow the correct steps. This guide will walk you through each section of the form to ensure all necessary information is provided accurately.

Follow the steps to complete the Dodd Hall referral form smoothly.

1. Use the ‘Get Form’ button to access the referral form and open it for editing.
2. In the section labeled 'Date,' enter the current date in the format MM/DD/YYYY.
3. Fill in the patient's name in the 'Patient's Name' field.
4. Enter the patient's birth date in the required format (MM/DD/YYYY) under 'Birth Date.'
5. Provide the patient's Social Security Number in the 'Social Security Number' section, formatted as XXX-XX-XXXX.
6. Complete the patient's address fields including 'Patient's Address,' 'State,' 'City,' and 'Zip Code.'
7. In the 'Patient's Phone #' section, fill in the appropriate numbers for home, cell, and work phones, including area codes.
8. Provide the reason for the consult in the 'Reason for Consult' text area.
9. Input the referrer’s details, including the 'Referring Physician,' 'Signature,' 'Address,' 'City,' 'State,' 'Zip Code,' 'Phone #,' and 'Fax #.'
10. If applicable, enter the primary care physician's information in the provided fields.
11. Indicate the current location of the patient by checking the appropriate box and providing additional information if necessary.
12. Mark all current medical conditions that apply and note the date of onset as required.
13. Detail the current health status, indicating whether there are any open wounds and describing the individual’s activity level.
14. If applicable, check the healthcare equipment or treatments needed by the patient on a regular basis.
15. Attach copies of the insurance card(s) as required.
16. Include any additional notes or instructions from the referring physician in the designated area.
17. Once you have filled out all sections, review the form for accuracy before saving it, printing it, or sharing it as needed.

Start completing your Dodd Hall referral form online today.