Get New Patient Referral Form - Karmanos Cancer Institute - Karmanos
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How to fill out the New Patient Referral Form - Karmanos Cancer Institute - Karmanos online
Filling out the New Patient Referral Form for the Karmanos Cancer Institute is a crucial step in referring patients for specialized cancer care. This guide will provide you with clear, step-by-step instructions to help ensure that you complete the form accurately and efficiently.
Follow the steps to successfully complete the referral form.
- Press the ‘Get Form’ button to access the referral form and open it in your chosen document editor.
- Fill in today’s date at the top of the form to indicate when the referral is being made.
- Provide referring physician information, including name, address (street, city, state, and zip code), office contact phone number, and fax number.
- Indicate whether the patient has been notified of the referral by marking 'Yes' or 'No' in the designated box.
- Complete the patient information section, including the patient’s name, address (street, city, state, and zip), sex, date of birth, preferred phone number, alternate phone number, and best time to call.
- If the contact person is not the patient, provide their name, relationship to the patient, and phone number.
- State the diagnosis or reason for the referral in the appropriate section.
- If applicable, specify the direct referral destination and the specialty the patient should see, such as medical oncologist, surgical oncologist, or radiation oncologist.
- Check all boxes for additional information needed by Karmanos Cancer Institute. This may include pathology reports, recent scans, lab results, chart notes, and previous cancer treatment documents.
- If applicable, understand that Karmanos can request items on behalf of the patient if they have a signed authorization to release medical records. Ensure to review where this form can be obtained.
- After completing all sections, you can save changes, download the form, print it, or share it as needed.
Complete the New Patient Referral Form online today to ensure timely assistance for your patient.
Headquartered in the city of Detroit, the KCI catchment area covers 46 of MI's 83 counties, an area that is home to 6.7 million residents. KCI's mission is to lead in transformative cancer care, research and education through courage, commitment and compassion.
Fill New Patient Referral Form - Karmanos Cancer Institute - Karmanos
New Patient Referral Form. Clinical Audit Programs. The Barbara Ann Karmanos Cancer Institute in Detroit is now offering an advanced, new treatment that's giving renewed hope to patients. Thank you for entrusting the care of your patients to Genesis Cancer and Blood Institute. Our clinics offer advanced treatments and a variety of services. Karmanos Cancer Center located in Detroit, MI is here to provide care to our patients with our primary and specialty care physicians. The Karmanos Cancer Center in Detroit, MI is a renowned institute offering a wide range of diagnostics and treatments for various types of cancers. The Karmanos Cancer Institute at McLaren Flint offers radiation therapy care for the Owosso area, providing expert care close to you.
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