Get Osu Physician Referral Form

The Osu Physician Referral Form is an essential document for referring patients to appropriate specialist care or testing. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently online.

Follow the steps to successfully fill out the Osu Physician Referral Form

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Indicate whether the referral is urgent by selecting ‘Yes’ or ‘No’. If the referral is urgent, fax the completed referral form to 614-293-1456 and call 614-293-5123 to expedite the order entry.
3. Select the type of referral: either ‘Specialist/Consultation’ or ‘Procedure/Testing Only’.
4. Fill out the patient information section, including the first name, last name, middle name, primary phone number, date of birth, street address, city, state, zip code, country, and the last four digits of the Social Security Number. Specify the gender and if the patient is non-English speaking, include their preferred language.
5. In the ‘Referral to’ section, indicate the department or specialty area required for the referral. Additionally, provide the reasons for the referral, the preferred physician if known, the diagnosis, and any applicable ICD-10 codes.
6. Complete the ‘Referring from’ section by providing your first name, last name, medical title (e.g., MD, RN), phone number, and NPI number.
7. Fill the 'Form Completed by' section with your name, street address, city, state, zip code, and fax number.
8. Ensure to obtain the required physician signature before submission.
9. Once all fields are completed, save your changes, and download or print the form as necessary. You may also share it via fax to 614-293-1456.

Complete the Osu Physician Referral Form online today for streamlined patient referrals.