Get Adult Urology Referral Fax Cover Sheet To: (please Check Beside ... - Med Unc

This guide provides a comprehensive overview of how to accurately complete the Adult Urology Referral Fax Cover Sheet. The referral process ensures that patients receive the appropriate care while facilitating communication between healthcare providers.

Follow the steps to successfully complete the referral fax cover sheet.

1. Click the ‘Get Form’ button to access the Adult Urology Referral Fax Cover Sheet and open it for editing.
2. In the 'TO:' section, select the appropriate location for the referral by checking the box next to the desired facility. Be sure to review the fax numbers provided for accuracy.
3. Complete the 'FROM:' section with your name, practice, phone number, fax number, and the total number of pages being sent, including the cover sheet.
4. Fill in the patient's information, including their name, preferred phone number, date of birth, and medical record number (MRN) if applicable. If the patient is new, indicate that they will be registered upon scheduling.
5. Specify the reason for the referral by checking the applicable box or providing details for 'Suspected Cancer' or 'Other'.
6. Enter the referring physician's name and practice information, as well as the contact person responsible for completing the form.
7. Detail insurance information by checking the appropriate box, providing additional specifics as needed, such as the type of private insurance or Medicare supplement.
8. Once all sections are filled out, review the form for completeness and accuracy. Ensure that all necessary information is included before submission.
9. Save your changes, then you can download, print, or share the completed form as needed for your records or to send it to the appropriate facility.

Encourage completion of the Adult Urology Referral Fax Cover Sheet online for seamless patient referral processes.