Get Consultation Request Form The Information In ... - Emory University - Pathology Emory

Filling out the Consultation Request Form from Emory University’s Department of Pathology is essential for accurate patient tracking and consultation processing. This guide provides clear, step-by-step instructions to assist users in completing the form efficiently and correctly.

Follow the steps to correctly complete the Consultation Request Form

1. Press the ‘Get Form’ button to access the Consultation Request Form and open it in your preferred editing tool.
2. Begin by filling out the 'Facility' section with the name of the facility requesting the consultation, along with the 'Date' of the request.
3. Enter the referring physician's name in the 'Dr. Name' field, along with their 'Phone' and 'Address'. Ensure that this information is accurate as it is necessary for contact and follow-up.
4. In the mandatory patient tracking section, provide the 'Pt. First Name', 'Last Name', 'Age', 'DOB', and 'Sex'. Make sure to check the accuracy of the birth date and sex designation, as these details are crucial for patient identification.
5. Input the patient's 'S.S. #', if applicable, and detail the materials submitted by specifying the number of slides and blocks, along with their corresponding Path numbers.
6. Describe the 'Site of Lesion' and include the 'Collection Date' accurately, as this information is essential to the evaluation process.
7. Indicate who to send the bill for this consultation to. Provide all relevant billing information, including the 'Person responsible for processing billing', their 'Billing email address', and 'Billing phone number'.
8. Complete the 'Referring pathologist' section by providing their details, along with 'Clinician Name', 'Address', and 'Phone number'.
9. Fill in the patient's insurance information completely, including name, address, phone number, policy number, group number, and insurance company details. Attach a copy of the front and back of the insurance card as required.
10. Remember to include one form per case and enclose a cover letter that outlines the clinical history and a copy of the surgical pathology report, even if incomplete.
11. Before finalizing, review all entered information for correctness and completeness. Save changes, then download, print, or share the form as necessary.

Complete your Consultation Request Form online today to ensure timely processing of your case.