Get Wound Center Rx Form - Presbyterian Healthcare Services - Phs

Filling out the Wound Center Rx Form for Presbyterian Healthcare Services is a straightforward process that ensures patients receive the necessary care for their wounds. This guide provides clear instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in the date at the top of the form. This date should reflect when the form is being completed.
3. Provide the referring provider's name and department in the designated fields. Ensure that the information is complete and accurate as it is vital for processing.
4. Enter the office address of the referring provider. This should include the full address to avoid any confusion.
5. Input the provider's telephone number and fax number. This information is essential for communication purposes regarding the referral.
6. Complete the patient's name in the appropriate field along with their telephone number and an alternate contact number if available.
7. Record the patient's date of birth in the specified field to verify identity and relevance to treatment.
8. Indicate the patient's insurance information accurately, ensuring that it is current and appropriate for billing purposes.
9. Attach any required documents such as the medication list, history and physical report, as well as pertinent lab or x-ray reports that relate to the diagnosis.
10. Select the appropriate evaluation and treatment options, marking either Wound, Ostomy, or Hyperbaric oxygen therapy as needed.
11. Provide a diagnosis in the designated section to ensure that the Wound Center understands the medical need.
12. Have the referring provider sign the order at the end of the form to validate the referral.
13. Once the form is completed, save your changes, download it for your records, print a copy if necessary, or share it as instructed.

Start filling out your Wound Center Rx Form online today to ensure timely referral and care.