Get Referring Physician Form

Filling out the Referring Physician Form online is a straightforward process that facilitates the referral of patients effectively. This guide will provide clear and detailed instructions to assist you in completing each section of the form accurately.

Follow the steps to complete the form online effectively.

1. To begin, click the ‘Get Form’ button to access the Referring Physician Form and open it for editing.
2. In the first section, fill in the referring physician's name, phone number, and fax number. Ensure that this information is accurate to avoid communication issues.
3. Next, provide the contact name of a person other than the referring provider if applicable. This can help streamline communication regarding the referral.
4. Circle the nature of the requested visit based on urgency: Routine, Priority, SAP, or STAT. Your selection will guide the scheduling process.
5. Indicate your preferred method of contact by circling one of the options: calling the office or calling the patient with the appointment.
6. Choose the preferred location for the appointment by circling one of the options provided: Fayette, Jonesboro, or Newnan.
7. Select your preferred provider from the list. Circle the name of the physician or nurse practitioner you wish to refer the patient to.
8. In the Reason for Referral/Diagnosis section, clearly articulate the reason for the referral. This helps the receiving provider prepare for the appointment.
9. Use the Additional Notes to Provider section to include any relevant information or instructions that may assist the receiving provider.
10. Complete the patient information section by entering the patient’s name, date of birth, best contact number, and email address.
11. Finally, ensure to fax the required documentation along with the completed form to the designated number, including a copy of the patient’s insurance card, any required insurance referral, and medical records.
12. After filling in all sections, review the form for accuracy. Save your changes and consider downloading, printing, or sharing the completed form as necessary.

Complete the Referring Physician Form online to ensure efficient patient referrals.