Fill Out Chla Referral Form In 5 Easy Steps

Quick Links :

Hide

Filling out a CHLA referral form can seem like a daunting task, but with the right guidance, it can be a straightforward process. In this article, we will walk you through the steps to fill out a CHLA referral form in 5 easy steps.

What is a CHLA Referral Form?

A CHLA referral form is a document used to refer patients to the Children's Hospital Los Angeles (CHLA) for medical treatment. The form is typically filled out by healthcare providers, such as pediatricians or primary care physicians, who want to refer their patients to CHLA for specialized care.

Step 1: Gather Patient Information

The first step in filling out a CHLA referral form is to gather the patient's information. This includes their name, date of birth, medical record number, and contact information. You will also need to provide the patient's insurance information, including their policy number and insurance provider.

Patient Information Requirements:

• Patient's name • Date of birth • Medical record number • Contact information (address, phone number, etc.) • Insurance information (policy number, insurance provider, etc.)

Step 2: Determine the Reason for Referral

The second step is to determine the reason for referral. This includes the patient's diagnosis, symptoms, and any relevant medical history. You will need to provide a clear and concise explanation of why the patient needs to be referred to CHLA.

Reason for Referral Requirements:

• Patient's diagnosis • Symptoms • Relevant medical history • Clear and concise explanation of why the patient needs to be referred to CHLA

Step 3: Choose a Referral Specialty

The third step is to choose a referral specialty. CHLA has a range of specialties, including cardiology, neurology, and oncology. You will need to choose the specialty that best matches the patient's needs.

Referral Specialty Options:

• Cardiology • Neurology • Oncology • Other specialties (list all available options)

Step 4: Provide Additional Information

The fourth step is to provide additional information. This includes any relevant test results, medical records, or other documentation that may be useful for the referral.

Additional Information Requirements:

• Relevant test results • Medical records • Other documentation (list all available options)

Step 5: Submit the Referral Form

The final step is to submit the referral form. You can submit the form online, by fax, or by mail. Make sure to follow the submission guidelines carefully to ensure that the form is processed correctly.

Submission Guidelines:

• Online submission: [insert online submission link] • Fax submission: [insert fax number] • Mail submission: [insert mailing address]

By following these 5 easy steps, you can fill out a CHLA referral form and ensure that your patient receives the specialized care they need.

We hope this article has been helpful in guiding you through the process of filling out a CHLA referral form. If you have any further questions or concerns, please don't hesitate to contact us.