Get Emory Wound And Hyperbaric Center - Emoryhealthcare

Completing the Emory Wound And Hyperbaric Center treatment referral form online is an essential step to ensure effective care for patients requiring specialized treatment. This guide will provide clear, step-by-step instructions to help you navigate the form efficiently.

Follow the steps to complete the treatment referral form

1. Press the ‘Get Form’ button to access the treatment referral form and open it in your document management system.
2. Begin by entering the patient's name in the designated field for 'PATIENT NAME.' Make sure to provide their full name as it appears on official documents.
3. Fill in the patient's address, including street address, city, state, and ZIP code in the appropriate fields.
4. Input the patient's home phone number and cell phone number in the respective fields. Ensure that the format is correct.
5. Enter the patient's Social Security Number (SSN) and date of birth (DOB) in the specified sections. This information is important for identification purposes.
6. In the 'REFERRING PHYSICIAN' section, provide the name of the physician referring the patient along with their office phone and fax number.
7. Next, in the 'INSURANCE' section, document the insurance plan, primary care physician's name, and their contact number. Indicate if a referral is needed by selecting 'YES' or 'NO.'
8. If the patient requires pre-certification or approval, fax a copy of the insurance card or relevant information to the designated number (404-686-4409).
9. Specify the location, type, and duration of the wound in the fields provided under 'PLEASE EVALUATE AND TREAT PATIENT FOR THE FOLLOWING WOUND(S).'
10. List any prior treatments the patient has received for the wound in the indicated area.
11. For hyperbaric oxygen evaluation, select the relevant indications from the list provided or specify 'OTHER' if applicable.
12. Finally, the referring physician must sign and date the form in the designated area, indicating their approval and verification of the details provided.
13. Once you have completed all fields, save your changes, and choose to download, print, or share the form as necessary.

Complete your treatment referral form online today for efficient patient care.