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Referral form to Kootenai Clinic Gastroenterology & Endoscopy 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Patient Name and Date of Birth in the designated fields. Ensure accuracy for proper identification.
- Input the Patient Phone Number(s) for contact purposes. This is crucial for follow-up communications.
- Fill in the Referring Provider's name and phone number. This information helps streamline communication between providers.
- Select one option from the 'Referring for' section, indicating whether it's an office consult or a specific procedure like Colonoscopy or EGD.
- Detail any Medical Condition(s) present by checking relevant boxes and providing additional information where necessary, such as the date of the last EKG.
- List any Medications, including diabetic medications and anti-coagulation details, ensuring you follow any specific protocols mentioned.
- Finally, review all sections for completeness before faxing this form along with any required documents to (208) 625-4596.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2020 | 4.8 Satisfied (106 Votes) |
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