Yale Skin Biopsy Referral Form - Yale Medicine 2026

1. Click ‘Get Form’ to open the Yale Skin Biopsy Referral Form in the editor.
2. Begin by entering today’s date at the top of the form. This helps track when the referral was made.
3. Fill in the patient’s name and date of birth accurately to ensure proper identification.
4. Provide both home and alternative phone numbers for easy communication regarding the referral.
5. Select the insurance provider from your records, as this is crucial for processing the referral.
6. In the 'Reason for Referral' section, confirm that it states 'SKIN BIOPSY'.
7. Include a brief description of any relevant medical history or symptoms related to the biopsy.
8. Indicate whether an EMG has been completed and if so, specify if it was normal or abnormal.
9. If applicable, note if the patient is taking Coumadin or on anticoagulation therapy, ensuring INR levels are below 2.0.
10. Complete the referring physician's details including name, address, phone, and fax number for follow-up.
11. Lastly, provide information for the primary care physician in a similar manner to ensure all parties are informed.

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