Palmetto pediatric gastroenterology 2025

1. Click ‘Get Form’ to open the palmetto pediatric gastroenterology 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 your name as the person making the referral, followed by the reason for referral. Check all applicable boxes such as Consultation or Outpatient Procedure.
4. Provide patient information including their name, gender, date of birth, and social security number. Ensure you include a minimum of two contact numbers for the guardian.
5. Complete insurance details by entering primary and secondary insurance information. Remember to fax copies of all insurance cards as required.
6. Input referring provider information including name, address, and contact details. Ensure all sections are filled out completely to avoid processing delays.
7. Review all entered information for accuracy before submitting. Make sure to attach any required records relevant to the patient's condition.

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