Get Ucsf Grand Rounds Intake Form - Dermatology

The UCSF Grand Rounds Intake Form for Dermatology is an essential document for requesting a patient's presentation at the Grand Rounds. This guide will walk you through each section of the form to ensure that you complete it accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it for filling out online.
2. Provide the requesting physician's information, including their name, phone number, office address, fax number, and email address.
3. Indicate whether you will be presenting the patient at Grand Rounds by responding 'Yes' or 'No' to the question provided. If using photographs, specify that as well.
4. Enter your preferred dates for the patient's presentation at Grand Rounds, including a first and second choice.
5. Address the pathology review needs by indicating whether there are pathology slides that need to be reviewed. If they are not already at UCSF, include the request for slide retrieval.
6. Fill out the patient information section, providing the patient's name, date of birth or age, and contact information.
7. Thoroughly document the patient's medical history, including any prior treatments and responses, pertinent medical history, laboratory results, and relevant pathology.
8. Specify if a particular UCSF dermatologist needs to be present at the visit and provide their name if applicable.
9. List any specific questions you have regarding the patient's diagnosis, treatment, or further work-up.
10. Once completed, fax this form to the UCSF Dermatology Academic Office or email it with the form attached, acknowledging the due date of 5 PM the Friday before the patient's presentation.

Complete the UCSF Grand Rounds Intake Form online today to ensure a smooth submission process.