Get Emory Healthcare Physician Referral Form 2019-2025
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How to fill out the Emory Healthcare Physician Referral Form online
Filling out the Emory Healthcare Physician Referral Form online is a straightforward process designed to ensure efficient referrals for patients. This guide provides detailed instructions for each section of the form to assist you in completing it accurately and effectively.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the Physician Referral Form and open it in your designated editor.
- Begin by selecting the specialty to which you are referring your patient from the provided options such as cardiology, dermatology, or psychiatry.
- Fill in the referring provider's information, including your name, practice, city and state, phone number, fax number, email address, and office contact.
- Provide the patient's information, including their name, address, date of birth, and if applicable, the parent or guardian's name.
- Indicate the preferred contact phone number for the patient by checking the appropriate option (home, cell, work).
- Specify if an interpreter is needed by selecting ‘Yes’ or ‘No’ and indicate the required language if necessary.
- Mark the urgency of the visit by selecting one of the options: routine (within 30 days), semi-urgent (within 2 weeks), or urgent (less than 48 hours). If the appointment is urgent, a follow-up call to the provided phone number is recommended.
- Describe the patient's medical issue and request any medical records necessary, including progress notes or previous work-ups, by checking the relevant boxes.
- For ongoing care or consultation, check the appropriate option and include the ICD-10 code related to the patient's condition.
- Once the form is fully completed, you can save your changes, download the form for printing, or share it as needed.
Take the first step in facilitating quality care by completing the Emory Healthcare Physician Referral Form online today.
Emory University and Emory Healthcare are not the same, but they are closely related. Emory University is an educational institution that includes various health programs, while Emory Healthcare is the clinical arm providing medical services and care. Together, they collaborate to advance healthcare education, research, and accessible care for patients.
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