Get Dr Robert Lewis Teays Valley Wv

This guide provides clear instructions on how to fill out the Dr Robert Lewis Teays Valley Wv referral form online. Whether you are completing this for yourself or on behalf of someone else, follow these steps to ensure accurate and complete submission.

Follow the steps to successfully complete the referral form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the patient's information, starting with the patient's name and address. Ensure all details are accurate and clearly written.
3. Provide contact numbers for the patient, including home, work, and cell phone numbers.
4. Enter the patient's social security number and date of birth correctly in the designated fields.
5. Identify a nearest relative whom you have permission to discuss the case with, including their full name, relationship to the patient, and phone number.
6. Complete the patient insurance information, including primary and secondary insurance providers, along with their respective ID and group numbers.
7. Fill out the referring physician's information, including their name, NPI number, address, office phone, fax, and contact person.
8. State the reason for the referral. Be as detailed as necessary for the referral to be processed efficiently.
9. Indicate the patient’s appointment with Dr. by including the date and time the appointment is scheduled.
10. Select how the patient was notified about the appointment, either by mail or by phone.
11. Include any additional information that may be relevant in the designated section.
12. Once all fields are completed, save your changes, and download, print, or share the form as required.

Complete your documents online now for a seamless process.