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Get Stanford Health Care Referral Request Form
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How to fill out the Stanford Health Care Referral Request Form online
Completing the Stanford Health Care Referral Request Form online is a straightforward process that ensures efficient processing of medical referrals. This guide provides step-by-step instructions to assist users in accurately filling out each section of the form.
Follow the steps to complete the referral request form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the patient information section. If you have included a Medical Records Cover Sheet, you may leave the patient information blank. Provide the patient's name (first, middle, last), date of birth, and contact phone number, ensuring that all required fields marked with ** are accurately filled out.
- Indicate the patient's sex by selecting the appropriate checkbox. Then, provide the reason for the referral, selecting the urgency priority (routine or medically urgent) and, if medically urgent, describe the situation.
- Enter the clinic or specialty requested and the specific physician, if applicable. Complete the address fields, including address, city, state, and zip code.
- Specify if an interpreter is needed by selecting 'Yes' and indicate the preferred language. Also, include the location requested for the appointment.
- If the requested physician is unavailable, indicate whether the patient can be seen by another provider by selecting ‘Yes’ or ‘No’. Choose the appropriate type of appointment (consultation, second opinion, procedure, or other).
- In the referring provider information section, fill out the provider’s name, practice name, office address, city, state, and zip code. Ensure that the provider's phone number and NPI number (if applicable) are included.
- Finally, check any relevant documentation requested such as clinical notes, a copy of the insurance card, or insurance authorization information if required before finalizing your submission.
- Once all information is provided, review the form for accuracy. You can then save changes, download, print, or share the completed form as needed.
Complete your referral request form online to facilitate timely medical assistance.
A referral request is a formal appeal to a healthcare provider for authorization to see a specialist. This request often includes information about your health condition and the type of care you require. By completing the Stanford Health Care Referral Request Form, you take a proactive step in ensuring that your medical needs are met effectively and efficiently.
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