Get Physician Referral Ongoing Communication Physician Referral Ongoing Communication
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Physician Referral Ongoing Communication online
Filling out the Physician Referral Ongoing Communication form is essential for TRICARE beneficiaries to access care with licensed mental health counselors. This guide will provide clear, step-by-step instructions to help users complete the form accurately and efficiently.
Follow the steps to complete your Physician Referral Ongoing Communication form.
- Click ‘Get Form’ button to access the form and open it in your preferred online editor.
- Enter the patient's name in the designated field at the top of the form.
- Input the date of birth (DOB) for the patient. Ensure the format is correct.
- Fill in the sponsor number, which is essential for TRICARE identification.
- Provide the patient's address, including city and state.
- Include the patient's phone number for any necessary communication.
- Indicate the reason for referral or disposition in the available field.
- Enter the ICD-9 diagnosis relevant to the patient's condition.
- Print the name of the licensed mental health counselor (LMHC), licensed professional counselor (LPC), or pastoral counselor (PC) receiving this referral.
- Select whether the referring physician (MD or DO) is providing 'Referral Only' or 'Referral and Ongoing Communication' by checking the appropriate box.
- Provide the referring physician's information, including name, whether they are a primary care manager (PCM), practice location, city, state, phone number, and date.
- Once all sections are completed, review the form for accuracy. After confirming all details are correct, you can choose to save your changes, download, print, or share the form as needed.
Complete your Physician Referral Ongoing Communication form online today for timely access to mental health services.
The physician who encourages open communication may obtain more complete information, enhance the prospect of a more accurate diagnosis, and facilitate appropriate counseling, thus potentially improving adherence to treatment plans that benefits long-term health.
Fill Physician Referral Ongoing Communication Physician Referral Ongoing Communication
This learning guide assists private practice physicians to understand better the importance of referral strategies. To ensure continuity of care, it is essential that you provide accurate patient information in your referral and patients return to you for ongoing management. A key source of patients will be referrals, and those rely on strong communication with fellow physicians.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.