Get Referral Form - State Of Oklahoma - Ok

The Referral Form for the State of Oklahoma is an essential document for reporting incidents related to trauma care. Completing this form accurately and thoroughly ensures that crucial information is submitted for review and improvement of the trauma system.

Follow the steps to fill out the Referral Form accurately.

1. Press the ‘Get Form’ button to access the Referral Form. This action will open the form in the editor.
2. Fill in the reporting individual's contact information. Include the date, full name or title, organizational affiliation, telephone number, address, and email address.
3. Provide a brief description of the information for review, including the date of the incident, the name of the patient, the patient's date of birth, your medical record number, and the name of any other involved agency or facility.
4. Indicate the reason for requesting the review by checking all applicable boxes. Be sure to include a brief narrative explaining the circumstances related to your selections, such as pre-hospital care, ED care, operative care, or any communication problems.
5. Attach any related documentation, which may include medical records, run reports, or other relevant files that support the information provided in your referral.
6. After completing the form, you can save your changes, download a copy, print it out, or share the completed form as required.

Start filling out the Referral Form online now to ensure timely and accurate reporting.