Get Unc Department Of Neurology - Med Unc

Filling out the UNC Department of Neurology referral form online is a straightforward process that requires accurate information to facilitate the consultation. This guide will help you navigate through the form efficiently and ensure that all necessary details are provided.

Follow the steps to complete the UNC neurology referral form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's information in the designated fields. Ensure to include their full name, UNC MR number, date of birth, mailing address, city, state, and zip code. Provide both a preferred and a secondary phone number for contact.
3. Input the insurance information and authorization number if needed. This information is crucial for processing the consultation.
4. Proceed to the referring care-provider information section. Fill in the referring physician's name, UNC ID, and UPIN. Additionally, include the clinic contact person's name, along with their phone and fax numbers.
5. Complete the pertinent medical history section. Clearly state the onset date of signs or symptoms. Avoid vague references like 'see notes' as this will cause delays in processing.
6. In the specific referral question section, provide a concise description of the referral reason. This helps the neurologist understand the specific concerns.
7. Indicate if the consult is urgent by selecting 'Yes' or 'No.' If urgent, ensure to communicate this clearly, as consultations needed within 48 hours will be prioritized.
8. Once all fields are completed, review the information for accuracy. After confirming all details are correct, you can save changes, download, print, or share the form as needed.

Take the next step and complete your UNC neurology referral form online today.