Get Division Of Gastroenterology - Med Umich

Filling out the Division of Gastroenterology consultation request form online can streamline the process of obtaining medical care. This guide provides detailed instructions to ensure a smooth completion of the required fields.

Follow the steps to complete the consultation request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter today's date in the designated field to document when the form is being completed.
3. Provide your contact name and phone number in the required fields, ensuring accuracy for any follow-up communications.
4. In Section 1, complete the patient information accurately. Fill in the patient’s name clearly, followed by their address, city/state/zip code, and date of birth in the specified format.
5. Document the telephone numbers for the patient and select their sex from the provided options.
6. Incorporate the patient’s insurance details, ensuring you select any required options and include additional contact numbers if necessary.
7. Move to Section 2, where you will need to enter the referring physician's name, UPIN number, address, and phone number. If the referring physician is not the primary care physician (PCP), also provide the PCP's details.
8. Proceed to Section 3 to describe the patient's medical history. Record the diagnosis and include details of any relevant studies or prior procedures, including their locations and dates.
9. Specify the type of appointment requested by choosing from the options provided: urgent, within 2 weeks; within 3-6 weeks; or routine for the next available appointment.
10. Add any additional comments that may assist in the scheduling or provide necessary context for the consultation.
11. Before finalizing the form, ensure that all required fields are completed to prevent delays. Save changes, then download, print, or share the form as needed.

Complete your consultation request form online today for efficient processing.