Get Fax Referral Form 813.doc - Medfusion

Filling out the Fax Referral Form 813.doc - Medfusion is a straightforward process that helps facilitate medical referrals efficiently. This guide provides step-by-step instructions to ensure you complete the form accurately and effectively.

Follow the steps to successfully complete the Fax Referral Form 813.

1. Press the ‘Get Form’ button to access the Fax Referral Form 813.doc online and open it in the specified editor.
2. Fill in the date at the top of the form to indicate when the referral is being made.
3. Enter the patient’s name in the designated fields for first name, middle initial (if applicable), and last name.
4. Provide the patient’s date of birth to establish their identity.
5. Include the patient's social security number in the required field.
6. Select the patient's sex by marking the appropriate box for either male or female.
7. Complete the primary care provider (PCP) section with the name of the patient’s primary care physician.
8. Fill in the address, including apartment or unit number, city, state, and zip code.
9. Record the patient's home, work, and cell phone numbers in the provided fields.
10. Indicate the primary insurance details, including the insurance provider’s name, contact/group number, and the policy holder's name and date of birth if different from the patient.
11. If applicable, provide secondary insurance information in the same manner as the primary insurance section.
12. Insert the referring doctor's name and contact information, including their phone number and fax number.
13. Clearly state the reason for referral in the designated section, selecting any relevant options such as consultation or specific testing.
14. Indicate whether a recent MRI or CT scan has been performed and where.
15. Note if the patient has a defibrillator or pacemaker by checking the corresponding box.
16. Confirm that all necessary records will be sent along with the referral, as appointments will not be scheduled until these are received.
17. Once all sections are completed, review the form for accuracy and clarity before saving your changes.
18. Finally, download, print, or share the completed Fax Referral Form 813.doc as needed.

Complete your documents online efficiently by following these instructions.