Get Referral Form - Spectrum Health - Spectrumhealth

The Referral Form for Spectrum Health is an essential document for initiating consultations with various specialists. This guide provides step-by-step instructions to help users fill out the form accurately and efficiently, ensuring proper processing of referrals.

Follow the steps to complete the Referral Form accurately.

1. Click the ‘Get Form’ button to obtain the Referral Form and open it in your preferred document editor.
2. Review the referral specialty and location section. Select the appropriate specialty from options such as neurology, neuropsychology, and more, along with the relevant location.
3. Fill out the patient information section. Enter the patient's name, date of birth, address, city, state, preferred contact phone, alternate phone, best time to call, email, and zip code.
4. Complete the insurance details by entering the primary and secondary insurance information, including IDs and group numbers. If applicable, provide the authorization number.
5. In the provider section, fill out the referring provider's name, phone, and fax number, as well as the primary care provider's information.
6. For the diagnosis section, include relevant signs and symptoms.
7. In the referral type selection, choose whether the referral is for consultation only, consultation and treatment, or specify details for neurosurgery consultation.
8. Indicate the urgency of the referral by selecting either routine or urgent, providing reasons if urgent.
9. Note whether the referring provider has spoken to a specialist and provide details of the conversation, including time and date.
10. Obtain the referring physician's signature to validate the referral.
11. If available, check off all required records to be sent with the referral, such as MRI results, lab work, and notes.
12. Complete the office use only section with the appointment date, time, and provider name, confirming the patient has been notified.
13. Review the entire form for completeness and accuracy before saving your changes, downloading, printing, or sharing the form.

Complete your Referral Form online today for expert assistance.