Uic oral surgery 2026

1. Click ‘Get Form’ to open the uic oral surgery document in the editor.
2. Begin by entering the 'Date of Referral' at the top of the form. This helps establish a timeline for your referral.
3. Fill in the 'Referring Practice / Doctor Name' along with their 'Phone' and 'Email'. This information is crucial for communication regarding the referral.
4. Next, provide patient details including 'Name', 'DOB', and 'Gender'. If the patient is a minor, include the 'Parent/Guardian' name.
5. Complete the 'Home Address' section, ensuring to include city, state, and ZIP code for accurate location identification.
6. Indicate insurance details by filling in the 'Insurance ID# / Plan'. This will assist in processing any claims.
7. Check all applicable reasons for referral in the designated section. Be sure to mark teeth to be extracted on the provided diagram.
8. If available, indicate whether radiographs are attached or will be mailed. This is important for assessment purposes.
9. Lastly, complete sections on medical history, special needs, anesthesia recommendations, and any additional comments before submitting.

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