Get Oh The Metrohealth System External Physician Referral Form 2018

Completing the OH The MetroHealth System External Physician Referral Form online is a straightforward process that ensures accurate communication of essential information for patient referrals. This guide will provide you with step-by-step instructions to assist you in filling out the form efficiently.

Follow the steps to complete the referral form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the date in the designated space. This information helps in tracking the referral request accurately.
3. Next, fill in the referring attending provider’s name with their first and last name clearly indicated.
4. Provide the provider's signature in the specified field to validate the referral.
5. Enter the referring provider's phone number and fax number to ensure that the MetroHealth System can easily contact you if necessary.
6. Indicate the facility where the referral is coming from by filling in the relevant field appropriately.
7. Input the patient’s name, ensuring it matches their identification records.
8. Enter the patient's social security number (SS#) in the provided space.
9. Fill in the patient's phone number to facilitate communication regarding their referral.
10. Record the patient's birthday in the designated format: month, day, and year.
11. Complete the patient's address to provide necessary location information.
12. Specify the insurance company details, including the ID number and group number, to ensure proper billing and insurance coverage.
13. Indicate the specialty department or procedure being requested and provide the name of the specific specialty physician if applicable.
14. Clearly state the diagnosis or reason for referral to inform the specialists about the patient's condition.
15. Lastly, remember to forward any progress notes that contain subjective and objective indications for the requested tests as needed.
16. Once all sections are filled out, you can save your changes, download a copy, print, or share the completed form as required.

Complete your document submission online for a seamless referral process.