Get Physician Referral Form - Baylor Health Care - Baylorhealth

Filling out the Physician Referral Form for Baylor Health Care is an important step in ensuring patients receive timely and appropriate medical care. This guide provides clear, step-by-step instructions to help you complete the form online with ease.

Follow the steps to successfully complete the Physician Referral Form.

1. Use the 'Get Form' button to access the Physician Referral Form and open it in the editor.
2. Begin by entering the patient's information in the designated fields. Provide the patient's name, date of birth, social security number, sex, and contact numbers.
3. Next, fill out the physician's information. Include the physician's name, phone number, contact person, fax number, and obtain the necessary physician signature and date.
4. In the insurance information section, input details for the primary and secondary insurance carriers, including the member ID and group numbers, insured name, and any required precertification numbers.
5. Proceed to the procedure information section. Enter the details for up to three procedures, including the procedure name, ICD-9/diagnosis code, scheduled date, clinical diagnosis, arrival time, comments, and appointment time for each.
6. Finally, complete the requested date and time section by entering the preferred date and select the time for the appointment.
7. Review the completed form for any missing information or errors. Once satisfied, save your changes, and consider downloading, printing, or sharing the form as necessary.

Start filling out your Physician Referral Form online today to ensure timely care for your patients.