Get Diagnostic Coagulation Center - Outpatient Consultant Referral Form - Med Dartmouth-hitchcock
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How to fill out the Diagnostic Coagulation Center - Outpatient Consultant Referral Form - Med Dartmouth-hitchcock online
Filling out the Diagnostic Coagulation Center - Outpatient Consultant Referral Form is essential for referring patients in need of coagulation consultations. This guide provides a step-by-step approach to help you navigate the online completion of the form effectively.
Follow the steps to accurately complete the referral form.
- Click ‘Get Form’ button to obtain the form and open it in the document editor.
- Begin by entering the referring provider's information. Include your name, office phone number, and fax number to ensure communication is open and effective.
- Next, enter the patient’s information, including their full name, date of birth, and daytime phone number. If the patient is under 18 years old, include the name of their guardian or parent.
- Indicate the urgency of the consultation by selecting between 'Urgent (Within 10 days)' or 'Stable (Next available).' Include the reason for consultation, choosing from options such as hemophilia, bleeding, thrombosis, or other. If applicable, list any specific questions you need answered about the patient's condition.
- Please indicate if records are available in the Dartmouth-Hitchcock clinical system and specify whether they are from CIS North or CIS South. If records are not available in the system, fax copies of relevant reports, including patient demographics and required medical documentation, to the provided fax number.
- Review the form for completeness. Ensure all required fields are filled correctly. Missing or illegible information may delay scheduling the appointment.
- After ensuring the form is complete, submit it according to the guidelines. You may save the changes, download, print, or share the form as needed.
Complete the referral process online today to ensure timely consultation for your patient.
Dartmouth Medical Center is designated as a Level I trauma center, which means it provides the highest level of surgical care to trauma patients. This designation underscores the center's capability to handle complex cases, ensuring that patients receive comprehensive care. Services like the Diagnostic Coagulation Center - Outpatient Consultant Referral Form - Med Dartmouth-Hitchcock are integral to this commitment to excellence.
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