Get Checklist For Tonsillectomy For Children Form

This guide provides comprehensive instructions on how to complete the Checklist For Tonsillectomy For Children Form online. By following these steps, you can ensure that all necessary information is accurately provided for effective review by the healthcare provider.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to retrieve the form and open it in your document editor.
2. Begin by entering the patient’s name in the designated field, ensuring accurate spelling.
3. Next, fill in the patient's date of birth in the correct format.
4. Provide the Anthem member number in the specified field to confirm insurance information.
5. Include the name of the primary care physician (PCP) in the appropriate section.
6. If applicable, enter the accompanying referral number and ensure the date of referral is filled out.
7. Review the patient’s history of recurrent throat infections by checking the relevant boxes based on the specified criteria.
8. Indicate if at least one associated factor with the episodes of throat infections is present by checking yes or no.
9. For further history, check all applicable factors related to recurrent throat infections.
10. If relevant, indicate if the patient has tonsillar hypertrophy or related conditions that may improve after tonsillectomy.
11. Confirm whether there is a suspicion of tonsillar malignancy by checking yes or no.
12. Lastly, the primary care physician must sign the form to validate it.
13. After completing the form, review all entries for accuracy. You can save changes, download, print, or share the completed document.

Complete your documents online today for a streamlined process.