Get Endoscopy Referral Order

This guide provides clear instructions on filling out the ENDOSCOPY REFERRAL ORDER. Whether you are a healthcare provider or a user assisting with the process, these steps will help ensure that the form is completed accurately and efficiently.

Follow the steps to complete the ENDOSCOPY REFERRAL ORDER online.

1. Click ‘Get Form’ button to access the ENDOSCOPY REFERRAL ORDER and open it in your preferred editor.
2. Begin by filling out the 'ORDERING PHYSICIAN' section. Enter your name, phone number, and email or fax number to ensure accurate communication.
3. Indicate the urgency of the referral by selecting one option from the TIME FRAME section: Urgent, 2 weeks, 3 months, or Other, and specify in the provided space.
4. Provide the PATIENT INFORMATION. Fill in the patient's name, date of birth, best contact number, and details of their primary care physician if different from the ordering physician.
5. Specify the PROCEDURE required. Choose from Colonoscopy, EGD, or Flexible Sigmoidoscopy and note the reason for the procedure by marking relevant options or specifying others in the provided space.
6. Complete the PATIENT MEDICAL INFORMATION section. Document any allergies, medication management specifically for anticoagulants, and any sedation concerns. Ensure to follow the notes regarding patient instructions where applicable.
7. Review the entire form for accuracy. Ensure all fields are filled correctly and necessary approvals or notes are included.
8. Finally, save your changes. Once saved, you may download, print, or share the completed ENDOSCOPY REFERRAL ORDER as required.

Complete your documents online today for a streamlined process.