Texs childrens hospital referral form w sedtion on line 2026

1. Click ‘Get Form’ to open the Texas Children's Hospital Referral Form in the editor.
2. Begin by entering the 'Date of Referral' at the top of the form. This helps track when the referral was made.
3. In the 'PATIENT INFORMATION' section, fill in the patient's last name, first name, middle initial, and address details including city, state, and zip code.
4. Indicate if a translator is needed by selecting 'Yes' or 'No', and specify the language if applicable.
5. Complete the parent/guardian's information along with their contact numbers. Ensure all fields are filled accurately for effective communication.
6. Provide details about the referring physician including their name, address for sending consult notes, and contact information.
7. Select the primary insurance carrier and provide its phone number. If an insurance referral is required, note that it should be faxed to 832-825-9332.
8. Check any relevant reasons for evaluation under 'PATIENT'S DIAGNOSIS'. This helps streamline the appointment process.
9. Finally, ensure that you have the referring physician sign at the bottom of the form before submission.

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