Get Hi The Queens Medical Center Fibroscan Order Form 2014-2025

Filling out the HI The Queens Medical Center Fibroscan Order Form accurately is essential for timely scheduling of your patient. This guide provides clear, step-by-step instructions to help you complete the form online, ensuring that all necessary information is included.

Follow the steps to complete the Fibroscan order form effectively.

1. Press the ‘Get Form’ button to obtain the HI The Queens Medical Center Fibroscan Order Form and open it in your editing interface.
2. Begin by entering the primary language of the patient in the designated field and indicate if an interpreter is needed by checking 'Yes' or 'No'. Note that if an interpreter is required, they must be arranged prior to the appointment.
3. Fill out the patient's name, date of birth (DOB), sex, address, social security number, and contact phone numbers under the patient information section.
4. Provide the patient's medical insurance information by attaching a copy of the insurance card (both front and back). It is important to fill in the primary and secondary insurance details, including the subscriber number and name.
5. Complete the referring physician's section, including their name, phone number, fax number, and address. This information is crucial for facilitating communication.
6. For the reason for referral, check the appropriate box corresponding to the patient's condition, selecting from options such as HBV, AIH, HCV, and others, or specify 'Other' if not listed.
7. Finally, the referring physician must sign and date the form to validate the referral. Ensure this is done before submitting the form.

Complete your Fibroscan order form online today to ensure your patient's timely care.