Get University Of Iowa Referral Form

Completing the University Of Iowa Referral Form online is an essential step in ensuring that referrals are processed promptly and accurately. This guide provides essential instructions for filling out each section of the form, making the process straightforward for all users.

Follow the steps to complete the University Of Iowa Referral Form online.

1. Click ‘Get Form’ button to obtain the referral form and open it in the designated editor.
2. Begin by filling in the required information under the 'Required Information' section. Enter the IowaCare Number, along with any pertinent medical information related to the patient's chief complaint, laboratory results, and radiologic reports.
3. In the 'Requesting Provider/Group' section, fill in the referring facility's name, contact phone number, and fax number.
4. Provide details of the referring provider, including their name and contact phone number.
5. Next, fill out the patient information section. Indicate if the patient has been seen at UIHC before by selecting 'Yes' or 'No.' Complete the patient's first name, middle name (if applicable), last name, birthdate, maiden name, alias, contact phone numbers, and address information.
6. Specify the reason for the referral request in the 'Reason for Request' section. Clearly describe any medical questions or concerns.
7. In the 'Patient Chief Complaint' section, provide a detailed explanation of the patient's chief complaint.
8. Outline any clinical requests or specialty clinic needs in the designated section. Be as descriptive as possible to facilitate better understanding.
9. Indicate the number of visits authorized and enter the expiration date of the referral.
10. Finally, save your changes, and choose to download, print, or share the completed form as needed.

Complete your University Of Iowa Referral Form online today!