Get 637-6691 () Referral Order Form - Vasco Infusion

Filling out the 637-6691 Referral Order Form - Vasco Infusion online is a straightforward process that ensures patients receive the necessary medication with ease. This guide provides clear, step-by-step instructions to assist users in completing the form accurately.

Follow the steps to complete your referral order form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the online editing platform.
2. Begin by entering the patient information, including the patient's name and date of birth. Ensure that all entries are accurate and legible.
3. Input the referring physician's details. This includes their name, practice address, contact phone number, email, phone number, and NPI/DEA number. This information is crucial for the verification and processing of the referral.
4. Select the appropriate medication/order change from the options provided. If this is a new referral or a request for a medication order change, check the corresponding box.
5. Indicate whether the patient has had any fractures and specify the indication/diagnosis by checking the relevant boxes provided. Provide additional notes if necessary.
6. Enter the required ICD-10 code for the patient's diagnosis. This information is essential for insurance processing and medical accuracy.
7. The referring physician must provide their signature and the date on the form, confirming the order and its details.
8. Ensure that you attach the required documentation, including recent office notes, lab results, and insurance cards. For new referrals, lab results such as Serum Calcium and DEXA results should be included.
9. Lastly, review all information for accuracy, and once completed, save changes, download, print, or share the form as necessary.

Complete your 637-6691 Referral Order Form - Vasco Infusion online to ensure timely processing and patient care.