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Doernbecher Referral Form

Use a Doernbecher Referral Form template to make your document workflow more streamlined.

N Insurance authorization if required Fax this form and pertinent medical records to 888 346-0645 or 503 346-0645. Clear Form Patient Information Patient Name n M n F Street Address City State Date of Birth / / Parent/Guardian Please check preferred contact phone number n Obesity Healthy Lifestyles clinic n Occupational n Home n Cell n Work Interpreter needed n Yes n No If yes Language Insurance Co. Member No* n Cochlear Implant Therapy n Dermatology n Ophthalmology n Diabetes n Orthopaedics n...

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What is the Doernbecher Referral Form

The Doernbecher Referral Form is a specialized document used to facilitate the referral of patients to Doernbecher Children's Hospital, part of Oregon Health & Science University (OHSU). This form is essential for healthcare providers to ensure that patients receive the appropriate care and services offered by the hospital. It collects necessary patient information, medical history, and the referring provider's details to streamline the referral process.

How to use the Doernbecher Referral Form

Using the Doernbecher Referral Form involves several straightforward steps. First, healthcare providers must complete the form with accurate patient information, including demographics and medical history. Next, the referring provider should specify the reason for the referral and any specific services required. Once completed, the form can be submitted electronically or via traditional mail, depending on the provider's preference. Utilizing electronic submission can expedite the referral process and ensure timely care for the patient.

Steps to complete the Doernbecher Referral Form

Completing the Doernbecher Referral Form requires careful attention to detail. Follow these steps for successful submission:

  • Gather patient information, including full name, date of birth, and contact details.
  • Document the patient's medical history and any current medications.
  • Clearly state the reason for the referral and any specific services needed.
  • Include the referring provider's information, including name, contact number, and practice details.
  • Review the form for accuracy and completeness before submission.

Legal use of the Doernbecher Referral Form

The Doernbecher Referral Form is legally binding when completed correctly and submitted according to the guidelines set forth by OHSU. It is important for healthcare providers to ensure that the information provided is accurate and truthful, as any discrepancies could lead to legal implications. Additionally, compliance with healthcare regulations, such as HIPAA, is crucial to protect patient privacy and maintain the integrity of the referral process.

Form Submission Methods

There are multiple methods to submit the Doernbecher Referral Form, allowing flexibility for healthcare providers. The options include:

  • Online Submission: Providers can fill out and submit the form electronically through OHSU's secure portal, ensuring a faster processing time.
  • Mail: The completed form can be printed and mailed to the appropriate department at Doernbecher Children's Hospital.
  • In-Person: Providers may also deliver the form directly to the hospital, which can be beneficial for urgent referrals.

Key elements of the Doernbecher Referral Form

The Doernbecher Referral Form includes several key elements that are critical for its effectiveness:

  • Patient Information: Essential details such as name, date of birth, and contact information.
  • Medical History: A summary of the patient's medical background and current health status.
  • Referral Reason: A clear explanation of why the referral is being made and what services are needed.
  • Provider Information: Details of the referring healthcare provider, including their qualifications and contact information.

Quick guide on how to complete doernbecher referral form

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How to create an eSignature for the doernbecher referral form

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Follow the step-by-step guidelines below to eSign your doernbecher referral form:

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  2. Hit My Signature.
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Related links to Doernbecher Referral Form
OHSU Doernbecher Children's Hospital referrals

Fill out one of our forms: Pediatric referral form · Diagnostic imaging referrals · CDRC referral form. Fax the referral to 503-346-6854. To send an ...Read more

Pediatric Interfacility Transfer Guidelines

Doernbecher Children's Hospital - Level I Trauma. Center Portland, Oregon. 1-800-648-6478 (Transfer Center). 1-888-667-2632 (1-888-66PANDA - PANDA Transport). 1 ...Read more

People also ask

Here is a list of the most common customer questions. If you can't find an answer to your question, please don't hesitate to reach out to us.

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The Doernbecher Referral Form is a specialized document designed to streamline the referral process for patients. With airSlate SignNow, you can easily create, send, and eSign this form, ensuring that all necessary information is collected efficiently. This feature not only saves time but also enhances the overall patient experience.

Using the Doernbecher Referral Form with airSlate SignNow is cost-effective, with pricing plans that cater to different business sizes and needs. You can choose from various subscription options that provide you with access to unlimited eSigning and document management features. Visit our pricing page for detailed information on the plans available.

The Doernbecher Referral Form includes features like customizable templates, secure eSigning, and real-time tracking of document status. Additionally, airSlate SignNow offers integration with popular applications, making it easy to manage referrals seamlessly. These features enhance your efficiency and provide a professional touch to your documentation.

Yes, airSlate SignNow allows you to integrate the Doernbecher Referral Form with various third-party applications such as CRM systems, cloud storage, and email platforms. This integration helps streamline your workflow and ensures that all your referral processes are interconnected and efficient.

Utilizing the Doernbecher Referral Form through airSlate SignNow offers numerous benefits, including reduced paperwork and faster processing times. It improves communication between healthcare providers and patients, ensuring that referrals are handled promptly. Additionally, the electronic format enhances security and compliance with healthcare regulations.

Absolutely! The Doernbecher Referral Form created with airSlate SignNow adheres to healthcare regulations such as HIPAA, ensuring that patient information is handled securely and confidentially. Our platform prioritizes compliance and security, giving you peace of mind when managing sensitive patient data.

With airSlate SignNow, you can easily track the status of the Doernbecher Referral Form through our user-friendly dashboard. You will receive notifications when the form is viewed, signed, or completed, allowing you to stay informed about the referral process in real-time. This transparency enhances communication and reduces follow-up inquiries.

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