Get Partnership Raf Form

Filling out the Partnership Raf Form online is a straightforward process that ensures your referral needs are met efficiently. This guide provides step-by-step instructions designed for all users, regardless of their experience with digital document management.

Follow the steps to complete the Partnership Raf Form online.

1. Press the ‘Get Form’ button to obtain the Partnership Raf Form and open it in your preferred editing tool.
2. Begin by filling in the member name, date of birth, and ID number. Ensure that all information matches the member's records accurately.
3. Provide the member's contact details, including address, phone number, city, and zip code. Accurate contact information is essential for effective communication.
4. Specify the services requested by checking the appropriate boxes: consult and/or continuing care, along with any desired follow-up arrangements.
5. Indicate if the requested provider is contracted with PHC and state whether the referral is urgent or indicated.
6. Fill in the reason for referral and any relevant medical history, including previous work-ups and treatments. Attach copies of lab reports or imaging studies if necessary.
7. Write down any questions that need to be answered as part of the consultation process.
8. Enter the primary ICD-9 diagnosis and provisional diagnosis, followed by the date of issuance.
9. Ensure the referring clinician's signature and printed name are included, along with their contact information for follow-ups.
10. In the consultant section, make selections regarding the final report and provide pertinent details such as phone number, fax number, and date seen. Lastly, ensure all necessary signatures are present.
11. Once all fields are completed, save your changes, and download, print, or share the form as needed.

Start completing your forms online today for a seamless referral process.