Stanford referral form pdf 2026

1. Click ‘Get Form’ to open the Stanford Referral Form PDF in our platform's editor.
2. Begin by filling in the 'Date' and '# pages' fields at the top of the form. Select either 'Routine' or 'Urgent' based on the urgency of the referral.
3. In the 'Referring Provider Information' section, enter your details including your name, medical group, phone, fax, and address. Ensure all information is accurate for effective communication.
4. Next, provide patient information. Fill in the patient's last name, first name, middle initial, date of birth, phone number, and gender. If an interpreter is needed, indicate this and specify the language.
5. In the 'Reason for Referral' section, detail the diagnosis/ICD code and specify the service or specialty requested. Indicate if you want to be contacted if your requested physician is unavailable.
6. Select the type of service requested from options like consultation or surgery. Lastly, list any required documentation that needs to be faxed along with this form.

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