Get Gyne.oncology/ Complex Gyne. Clinic Referral Form - Bcc Socialproof

Filling out the GYNE.ONCOLOGY/ COMPLEX GYNE. CLINIC REFERRAL FORM is essential for the referral of patients requiring specialized gynaecological care. This guide will provide clear and systematic instructions to assist users in accurately completing the form online.

Follow the steps to effectively complete the referral form.

1. Press the ‘Get Form’ button to retrieve the GYNE.ONCOLOGY/ COMPLEX GYNE. CLINIC REFERRAL FORM and open it in a suitable editor.
2. Begin by filling out the patient details section. Include the patient's name, address, date of birth, and telephone numbers (home and work). Ensure that this information is accurate.
3. In the referring MD section, enter the name of the referring medical doctor, their billing number, telephone number, and fax number.
4. Provide the patient's health number (PHN #) for identification and billing purposes.
5. Next, move to the patient history section. Clearly indicate the reason for referral by selecting the relevant options. Include the cytology lab ID number.
6. If applicable, indicate any pertinent medical history or conditions by checking the relevant boxes such as 'Pelvic Mass' or 'BRCA carrier'. If 'Other' is selected, specify the condition.
7. Attach copies of recent investigations that relate to the patient's condition, such as imaging results or bloodwork reports. Ensure to check the appropriate boxes for these attachments.
8. Indicate if the patient is pregnant and provide the due date if applicable.
9. List any allergies the patient may have and specify any disabilities, providing details on assistance required.
10. Confirm the patient's fluency in English and specify any other language spoken if necessary.
11. List any other physicians who should receive copies of the results, along with their billing numbers.
12. After completing all sections of the form, ensure that all information is accurate and complete to avoid delays. The completed form should be sent via fax to the number provided.

Start filling out the GYNE.ONCOLOGY/ COMPLEX GYNE. CLINIC REFERRAL FORM online today for efficient patient referral.