Please have the following information about patients ready to speed up your referral request quickly: Referral forms are very popular and are suitable in different areas of life. For example, they can be used in healthcare when a patient is referred to another medical facility, in retail when a customer is referred to a business, or in manufacturing when entrepreneurs are referred to a business, etc. This type of template can be used on behalf of a person who needs a recommendation for employment, enrollment in a specific educational institution or program, or treatment in a medical institution. If you prefer to fax your application, complete one of the following forms: Visit the Dartmouth-Hitchcock Manchester Referrals page to download the Complex Primary Care Appointment Request/Transition of Care form. Reference forms are the standard for all special paediatric wards, with the exception of sleep studies at Paediatric Neurology in Manchester. Please use the following specific form. In general, referral forms require you to fill in information about the referring party, information about the receiving party, client information (or patient information, depending on the type of referral form), the reason why the client was referred and the type of services they need. Its content may be changed due to the situation and the reasons why the form is used, although most parts are still included. For more forms, see the Recommendation Forms page on the Dartmouth-Hitchcock website. These forms are provided to you to speed up the planning process. A completed form is required to arrange these appointments. Please print the form and have it completed by the attending physician and fax it to: 617.638.6756.
Note: To download the electronic versions of these forms, please select the correct form, if available, on the Adult Referral Forms page or on the Pediatric Reference Forms page. As soon as your request has been received, it will be connected to our tracking system. A representative of the Connection Center acts on your behalf to facilitate your request by contacting the appropriate sections and following the request until it is completed. Your practice will be informed of the date, time and location of the patient`s appointment as soon as it is scheduled. Depending on the urgency of your request and the need to contact the patient for planning purposes, response times may vary. Call the DHMC Physician Connection Center (healthcare professionals only) Monday through Friday from 8:00 a.m. to 5:00 p.m.m.m. Looking for printable reference forms? Download them from our library below. A reference form is a document that can be used in many different situations when a company represented by one of its specialists wishes to refer its client to another entity for a reason.
The purpose of the document is to provide the client with a specialist who can provide the services that the client needs and the referring specialist is not able to provide it. A registered nurse will respond immediately to your reminder and register your patient immediately. To transfer or admit a patient, please call our one-call patient intake service, which is available 24 hours a day, 7 days a week. Pager number: 617.638.5795, #1111. At Boston Medical Center, we value our referring physicians and recognize both the demands of your working hours and the critical importance of meeting the complex needs of your patients. To provide you with seamless and easy admission, BMC offers a one-call patient enrollment process whenever you need it. Fax your application and all relevant patient notes to the Physician Connection Centre. Please call the provider or service directly. Please use our online directory of doctors and specialists or visit our list of specialized care to find the department`s website to find the appropriate phone number for your call.