Get Referral Form - Camc.org - Camc

Filling out the Referral Form for CAMC Women and Children’s Hospital is an essential step in ensuring a smooth referral process for patients. This guide aims to provide clear instructions on each section of the form to assist users in completing it efficiently and correctly.

Follow the steps to fill out the referral form accurately.

1. Press the ‘Get Form’ button to access the Referral Form and open it in the online editor.
2. In the 'Referred by (Dr.)' section, enter the name of the referring physician along with their contact phone number.
3. Fill in the 'Office address' of the referring physician, making sure to include the complete address.
4. In the 'Please schedule (patient name)' section, enter the name of the patient being referred, along with their age and phone number.
5. Specify the doctor the patient is to see by selecting 'DR. HORSWELL'.
6. In the 'Please evaluate for' section, circle the suspected diagnosis from the list provided. If there are additional concerns, you may fill in the 'Other (description)' section.
7. Locate the area of concern on the included diagram and mark or circle it accordingly.
8. After all fields are completed, you can choose to save the changes, download, print, or share the form as necessary.

Take the next step for a successful referral by completing the form online.