Get Vantage Medical Group Referral Request Form San Diego

Filling out the VANTAGE MEDICAL GROUP Referral Request Form SAN DIEGO online is a straightforward process that ensures your referral is processed efficiently. This guide provides step-by-step instructions to help you complete the form accurately.

Follow the steps to fill out the VANTAGE MEDICAL GROUP Referral Request Form SAN DIEGO online.

1. Click the ‘Get Form’ button to access the form and open it in the designated editor.
2. Begin by entering the patient's first name and last name in the appropriate fields.
3. Specify the patient's gender by selecting the relevant option.
4. Fill in the patient's address, including street, city, state, and zip code.
5. Provide a contact phone number for the patient.
6. Indicate the health plan by choosing from the dropdown or entering the name.
7. Enter the referring provider's name, contact phone number, fax number, and address.
8. Input the referral number, ensuring to note that it does not guarantee payment.
9. Include the provider's NPI number and office contact for further verification.
10. Complete the requested provider sections with the physician or facility name, phone, age, and NPI number.
11. Specify the patient's date of birth and provide a diagnosis, as well as the mandatory ICD-9 code.
12. Clearly articulate the services requested, being specific about the consult, follow-up, or treatment needed.
13. Attach all required documents such as progress notes, lab results, or X-ray results to support your request.
14. Verify all entered information for accuracy before final submission.
15. Once completed, save your changes, download, print, or share the form as needed.

Complete the VANTAGE MEDICAL GROUP Referral Request Form online to ensure your referral is processed quickly and efficiently.