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Get Telephone Triage/Message Form

to patient: Allergies Phone # Patient’s Age Weight Work Phone # Pregnant? Primary Care Physician Cell Phone # From _____am/pm To _____ am/pm Patient can be reached at home on cell at work Problem/Patient Complaint (cont. if necessary): Medication refill (circle) Medication Pharmacy Name Phone # Follow up: ER referral Appointment made for ________________ at _________ Physician to call. Physician called on ______________ at _________. Pharmacy called. Refill ready at _________.

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The days of terrifying complicated tax and legal forms are over. With US Legal Forms submitting official documents is anxiety-free. A powerhouse editor is right close at hand supplying you with a wide variety of beneficial tools for submitting a Telephone Triage/Message Form. These tips, along with the editor will assist you through the whole procedure.

  1. Click the orange Get Form button to begin editing.
  2. Switch on the Wizard mode on the top toolbar to have extra tips.
  3. Complete each fillable field.
  4. Ensure that the details you fill in Telephone Triage/Message Form is updated and correct.
  5. Include the date to the form with the Date option.
  6. Click the Sign tool and make an e-signature. You will find 3 available alternatives; typing, drawing, or uploading one.
  7. Re-check each area has been filled in properly.
  8. Select Done in the top right corne to save the sample. There are various ways for receiving the doc. An attachment in an email or through the mail as a hard copy, as an instant download.

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