Get Temporo-mandibular Joint Referral Form - Gloucestershire ...

Filling out the Temporo-mandibular Joint Referral Form is an essential step in ensuring that patients receive the appropriate care. This guide provides a clear and supportive approach to completing the form online, making the process easier for all users.

Follow the steps to complete the referral form effectively.

1. Press the ‘Get Form’ button to access the form, and open it in your preferred editing tool.
2. Enter the patient's name and date of birth in the specified fields. Ensure the date is formatted as DD / MM / YYYY.
3. Fill in the MRN number, NHS number, and, if applicable, affix the hospital label in the designated area.
4. Indicate the referral destination by selecting Gloucestershire Royal Hospital or Cheltenham General Hospital.
5. Note the date of referral in the specified format. Re-enter the patient’s date of birth as required.
6. Select the patient's gender by checking the appropriate box for male or female.
7. Complete the patient details section, including address, postcode, and telephone numbers (home, work, and mobile).
8. Specify if the referral is NHS or private by checking the corresponding box.
9. Document all medical conditions, allergies/reactions, and medications relevant to the patient.
10. In the Symptoms section, describe issues such as joint noise, muscle pain, and limitation of jaw opening. Provide detailed frequency and impact where necessary.
11. Record the onset of symptoms, indicating whether they were sudden or gradual, and note any known causes.
12. Detail any exacerbating factors and summarize treatment already administered, including impacts observed.
13. Note any relevant parafunctional habits, whether they are ongoing or ceased, and confirm that tooth decay and periodontal disease have been ruled out as pain causes.
14. Provide the name, signature, and address of the referring dentist or doctor. Ensure the print name is legible.
15. Date the form appropriately and ensure all sections are fully completed to prevent delays.
16. Once completed, save your changes, and prepare to download or print the form for submission.

Complete your referral form online today to ensure timely patient care.