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Get Duke University Health System Request For Pediatric Specialty Services 2009-2025
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How to fill out the Duke University Health System Request For Pediatric Specialty Services online
Filling out the Duke University Health System Request For Pediatric Specialty Services form online is a straightforward process. This guide provides a step-by-step approach to ensure that you can complete the form accurately and efficiently.
Follow the steps to successfully complete the form online.
- Click the ‘Get Form’ button to access the form and open it in the appropriate editor.
- Begin by entering the patient's information, including their first name, middle initial, last name, Duke MRN (if available), gender, address, city, state, zip code, home telephone number, alternate telephone number, and birth date (formatted as Month, Day, Year).
- Provide the name of the parent or guardian who is filling out the form.
- In the 'Reason for Referral' section, clearly state the reason for the request. For immediate assistance, use the contact number provided (1-800-MED-DUKE).
- Detail the history, symptoms, potential diagnosis, and any special needs relevant to the patient's condition in the designated section.
- If you are sending additional information along with the fax, check the provided box and describe the additional data.
- Select the requested pediatric services from the list provided, including options such as immunology, hematology-oncology, general surgery, and more.
- If applicable, indicate if you are requesting a specific provider, but note that this may cause delays in scheduling an appointment.
- Fill in the referring physician's information, including their name, date of referral, office address, city, state, zip code, fax number, email address, and preferred method of contact.
- Complete the confirmation section with the appointment date (formatted as Month, Day, Year), the program or physician involved, clinical location, and the date confirmation was sent to the referring medical doctor.
- Once all sections are filled out, review the information for accuracy. You will then have options to save changes, download, print, or share the completed form.
Complete your document online today to ensure timely pediatric specialty services.
Duke Hospital typically retains medical records for a minimum of 10 years. This timeframe ensures that patients have access to their medical history when needed. If you need your child's medical records for pediatric specialty services, it's best to request them while they are still accessible. Keeping accurate records supports ongoing health assessments and future medical decisions.
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