Get Arrhythmia Referral Form - Ns6391

The Arrhythmia Referral Form - NS6391 is an essential document used to refer patients for specialized arrhythmia services. This guide will provide you with clear and instructive steps to complete the form accurately online.

Follow the steps to complete the Arrhythmia Referral Form - NS6391 online.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Enter the date of referral in the format yyyy/mm/dd. This section helps establish the timeline for the patient's care.
3. Input the patient's full name, ensuring you spell it correctly to avoid any identification issues.
4. Select whether the patient is an inpatient or outpatient by checking the appropriate box.
5. Fill in the patient's contact numbers, including home and work phone numbers. Ensure all numbers are accurate.
6. Provide the patient's home address, including city, postal code, and date of birth (yy/mm/dd).
7. Complete the health card number field to facilitate the referral process.
8. Enter the referring physician's name and billing number to ensure proper coordination and billing.
9. Fill out the referring physician's address, telephone number, and fax number for communication regarding the referral.
10. Detail the diagnosis or reason for referral, providing sufficient context for the arrhythmia service team.
11. Indicate the requested service by checking the appropriate options, including consultation or specific procedures like cardioversion.
12. Include any existing rhythm strips or relevant cardiac investigations such as ECG, stress tests, and clinical notes.
13. Review all information for accuracy and clarity before proceeding.
14. Save your changes, and if necessary, download, print, or share the completed referral form.

Complete the Arrhythmia Referral Form - NS6391 online today to ensure timely care for patients.