Get Referral Form - Orthopedic & Neurosurgery Partners

This guide provides clear and comprehensive instructions on completing the Referral Form for Orthopedic & Neurosurgery Partners online. Follow the steps carefully to ensure accurate and efficient submission of your referral.

Follow the steps to fill out the referral form correctly.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing the patient's information, including their full name, date of birth (DOB), and contact details such as home, work, and cell numbers.
3. Specify the patient's address, including the city, state, and zip code. This ensures that the referral can reach the appropriate location.
4. Indicate the type of accident by checking the appropriate option, whether it is an auto accident or a slip & fall case. Provide the date of the incident.
5. Fill in the attorney's information, including their name, firm name, and contact details. Make sure to include email and fax numbers for expedited communication.
6. State whether the Personal Injury Protection (PIP) has been exhausted by selecting 'Yes' or 'No.' Include details on accumulated medical bills and any remaining PIP.
7. Include information about the referring physician, such as their name, phone number, address, and email. This assists in establishing communication for the patient's care.
8. Document the chief complaint and symptoms that the patient is experiencing. If applicable, check if surgical evaluation and other treatments are needed.
9. Provide information regarding the insurance carrier, including the type of insurance, policy number, claim number, and relevant policy limits.
10. Finally, review all entered information for accuracy. Once verified, you can save changes, download, print, or share the form as required.

Complete your documents online today and ensure a smooth referral process.