What does a doctor referral look like 2025

1. Click ‘Get Form’ to open the Doctor’s Office Referral Form in our editor.
2. Begin by filling out the Patient Information section. Enter the patient's name, date of birth, gender, and contact details including phone numbers and addresses.
3. Complete the Emergency Contact field with the necessary information, ensuring you include their relationship to the patient.
4. Fill in the Referring Doctor and Plan of Care Doctor sections with their names and phone numbers.
5. Specify the Primary and Secondary Diagnoses clearly to ensure accurate treatment.
6. Indicate the Service(s) Needed by checking all applicable boxes for services such as Skilled Nursing or Physical Therapy.
7. Document any Treatment Orders and Allergies in their respective fields for comprehensive patient care.
8. For Medicare patients, complete the Face To Face Encounter section, including date and reason for home health care.
9. Finally, ensure that both Physician Signature and Printed Name are filled out before saving your document.

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