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Facility Intake Form for Professional Imaging Mobile Dysphagia Consult

Facility Intake Form for Professional Imaging Mobile Dysphagia Consult 2025

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The document is a Facility Intake Form for scheduling a Mobile Dysphagia Consult, outlining required information and documentation needed to assess patients with swallowing difficulties. It includes sections for patient details, symptoms, medical history, and specific assessments needed for dysphagia evaluation. The form emphasizes the importance of completing all sections to avoid scheduling delays and requires signatures and consent from healthcare professionals.

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