Get Urodynamics Referral Form

Completing the Urodynamics Referral Form online can streamline the process of referring patients for urodynamic testing. This guide provides clear instructions on how to accurately fill out each section of the form to ensure a smooth referral process.

Follow the steps to fill out the Urodynamics Referral Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the patient's information. Provide the patient's name, address, phone number, hospital number, date of birth, and preferred contact methods, ensuring all sections are filled in completely.
3. Indicate the sex of the patient by selecting the appropriate checkbox for either 'Male' or 'Female'.
4. Select the doctor to whom the referral is being made by marking the corresponding checkbox next to Dr. Lewis Chan, Dr. Vincent Tse, or Dr. Ruth Collins.
5. Specify the required test by selecting either 'Video Urodynamic' or 'Non-video Urodynamic'.
6. Assess and document the patient's ambulatory status by selecting one of the options available: 'Ambulatory', 'Uses walking frame/stick', 'Uses wheelchair', or 'Requires limited assistance'.
7. Provide details about the indication for study by marking all relevant symptoms under obstructive, irritative, and incontinence categories, and specify any additional issues as needed.
8. If applicable, indicate any urinary problems associated with neurological disorders by selecting any relevant conditions listed.
9. Document any urinary problems following surgery by marking the appropriate boxes and providing additional specifications where required.
10. List any current medications the patient is taking by filling in the names of medications in the provided fields.
11. Add any additional comments relevant to the referral in the comments section.
12. Fill out the referring doctor's details completely, including name, provider number, signature, date, and address.
13. Once the form is completed, review all entered information for accuracy. After confirming everything is correct, save the changes. You may also choose to download, print, or share the form as needed.

Complete the Urodynamics Referral Form online today for an efficient referral process.