Follow the steps to fill out the Mosaic Access Clinic referral form.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the referral date at the top of the form. Make sure this date is accurate as it is essential for processing the referral promptly.
3. In the Patient Demographics section, fill in the necessary information regarding the patient. Ensure all details are correct, as this will facilitate the referral process.
4. Complete the Referred By section by including your contact information and attaching the patient label if available. If a physician stamp is applicable, place it below the contact information.
5. Select the appropriate urgency level for the referral by checking either 'within 4 hours' or 'within 24 hours.' This indicates how soon the patient requires attention.
6. Provide details in the Inclusion Criteria and Exclusion Criteria sections to clarify the patient's eligibility for the clinic. Be thorough to avoid any delay in the referral.
7. In the Issues/Concerns section, list any relevant concerns or issues regularly seen in family physician offices that the patient is experiencing. This will inform the clinic of the patient's needs.
8. Document the Reason for Referral in the respective section. This information helps streamline the assessment process for the referral.
9. Attach any relevant information that may support the referral, such as medication lists, lab results, or previous consults, to provide additional context for the clinic.
10. Once all fields are completed, you can save changes made to the form. After this, you may choose to download, print, or share the form as needed.

Complete and submit the Mosaic Access Clinic referral form online today to ensure timely patient care.