Get Nh Dartmouth-hitchcock Medical Center Referral Form For Pulmonary Function Lab 2016-2025

Filling out the NH Dartmouth-Hitchcock Medical Center Referral Form For Pulmonary Function Lab online can streamline the referral process and ensure comprehensive patient evaluation. This guide provides clear steps to complete the form accurately and efficiently.

Follow the steps to complete the referral form online:

1. Click the ‘Get Form’ button to obtain the referral form and open it in your online editor.
2. Provide the date of the referral in the designated field.
3. Enter the patient's date of birth in the specified section.
4. Fill in the patient's name, including last name, first name, and middle initial.
5. Complete the patient's address, ensuring accuracy for potential correspondence.
6. Input the patient's home, cell, and work phone numbers in the relevant fields for contact purposes.
7. Specify the referring physician's name and their practice address.
8. Input the office phone number and office fax number associated with the referring physician.
9. Include the contact name for the referral, ensuring it is a person who can address follow-up questions.
10. In the 'Reason for Referral/Indication' section, check all relevant boxes that apply to the patient's condition.
11. Select the pulmonary function tests being ordered by checking the appropriate boxes.
12. Review the suggestions for ordering pulmonary function tests to ensure appropriate selections are made.
13. Ensure the referring physician's signature is provided before submitting the form.
14. Once all information is accurately filled out, you can save changes, download, print, or share the completed form.

Complete the NH Dartmouth-Hitchcock Medical Center Referral Form For Pulmonary Function Lab online today.