Referral form

Some patients will be seen for multiple reasons therefore, the pharmacist may need to record more than one ICD-9-CM code to fully describe the patient visit. For example, if a client with coronary artery disease (CAD) is referred to a pharmacist, it may not be uncommon that the physician requests education on lowering cholesterol through both diet and medications and education on weight loss and smoking cessation. All three conditions (CAD, obesity, and tobacco use) can be coded to represent the health conditions discussed. Example ICD-9 codes for these conditions include 414.01 (native-vessel disease), 272.2 (mixed hyperlipidemia), and 305.1 (tobacco-use disorder) (Buck and Lockyear, 2007). The specific ICD-9 code used on the claim form should be the same code used by the physician to decrease the risk of claim rejection owing to mismatched codes. Therefore, the ICD-9 code should be requested on the referral form from the physician (Snella et ah, 2004). 

Following the patient visit, a claim form (CMS 1500 or CMS 1450) is filled out and submitted to the insurance carrier. The insurance carrier may want other items before approving the claim, such as a statement of medical necessity from the referring provider and a copy of the physician s referral. A statement of medical necessity is a statement signed by the provider that states that the referral to the pharmacist (or other provider) is necessary medically (Snella et al., 2004, Poirier et al. 1999). This type of statement can be incorporated into the physician referral form (Snella, 1999). 

Dr. Brouchard develops a referral form for his service and has included fields for the physician s office to complete regarding the type ofinsurance, the policy number, the ICD-9 codes, and the physician s provider number. He plans on requesting that referring physicians complete a referral form for each patient they send to the service. If a patient approaches him directly for the service, he plans on contacting his or her physician... 

The referral form also includes check boxes for the physician to mark the appropriate ICD-9-CM codes. For diabetes education, he includes the common ICD-9 codes 250.00 (i.e., uncomplicated type 2 diabetes, controlled), 250.02 (i.e., uncomplicated type 2 diabetes, uncontrolled), and an Other field with room for the physician to add a more specific code (Buck and Lockyear, 2007). For the hyperlipidemia component, he has also included the common codes used to describe these conditions. Within the referral form is the statement of medical necessity and contact information for the physician and patients to reach the pharmacy to make appointments. Although Dr. Brouchard likes the form that he has created, he plans on revising the form based on his experience and input from the physicians office after a few months of use. He wants to make sure that the referral form is as easy to use as possible and that it contains most of the information he needs to submit claims successfully. 

What information would you want on a referral form for an asthma education and monitoring, weight-loss, or osteoporosis counseling service ... 

Communication with other healthcare professions will include both verbal and written communication. For example, patient referral forms would be a form of written communication from the pharmacist to the prescribes These forms concern information that the pharmacist may have obtained ... 

Nutrition assessment is a systematic approach to collect, record, and interpret relevant data from patients, clients, family members, caregivers, emd other individuals and groups. Nutrition assessment is an ongoing, dynamic process that involves initial data collection as well as continual reassessment and analysis of the patient s/cUent s status compared to specified criteria Screening or referral form Patient/cUent interview Medical or health records... 

Referral forms, useful phone numbers (Appendix F)... 

Referral forms Letter/fax/email/telephone discussion ... 

Referrals to the panel need to be on a single referral form - this will cover referrals for learning, behaviour and any other additional support that is needed. They must be completed in a consistent and informed way by staff. 

Common referral and communication systems, that is, referral forms/protocols, case conferences, access to student data. 

Within the Inclusion Team there will be a platform of plans - Individual Education Plan, Personal Support Plan, Looked After Children Plan - the list is endless. Keep it simple - a plan is a plan, and the same format can be used to cover most of the aspeas that are required. In the same vein, referral forms will need to be consistent and there should be clear expectations of staff as to the quality and depth of information required for a referral. 

In summary, over a large range of interchain distances, the most stable species photogenerated in the lowest excited stale of clusters formed by identical molecules are excitons mostly with an intrachain character. The calculations also show that po-laron-pairs, also referral to as interchain excitons (corresponding to a positive polar-... 

Making a proper referral is an art form, one part of which — the when and why to make a referral — was discussed in the previous chapter. Another part of that artistry involves making the referral in an appropriate way. For the sake of simplicity, there are certain dos and don ts related to making an appropriate referral. For example, do make referrals in a timely fashion. Our clients often need help quickly when a referral is necessary. Delay can harm progress. Related to this, do make sure that you have your client sign a release so that you can talk with another professional about the client, and do make sure there is little to no lapse in treatment services between referral to appointment. 

Medication and/or dosage changes will be made, if necessary, based on the pharmacists assessment, and patients will be counseled on these changes. The physician communication form will be used to communicate clinical recommendations regarding drug therapy. Also, patient education will be reinforced and documented. Patients will be instructed on when to return to the clinic, and referrals to physicians will occur as needed. The referrals are based on patient complications of therapy or condition and patient resistance to therapy. 

It should also be emphasised to Mr AP that it is important to maintain a healthy diet during the period of dysphagia. A referral to a dietitian by his clinician may be advisable to enable an assessment of diet requirements to be made and advice to be given on alternative nutritional supplements (in liquid form) if required. 

Typically in this country, CISD is not a form of treatment or therapy rather, it is a psychoeducational approach for those who may be at risk for development of psychiatric disorders in the future. It can be useful, therefore, as a tool to identify group members who may need additional assistance or referral. Most commonly, CISD refers to the group intervention model developed by Mitchell. This model is typically applied within 24 to 72 hours, and covers seven phases ... 

Whenever a product and its medical claim are promoted, there must be provision for the recipient of the information to obtain additional comprehensive information about the product. Advertising in print must be accompanied by the brief summary of risks. The FDA permits print advertising directed at the consumer to be accompanied by a consumer-directed brief summary, which can be in the form of a Q A. If a product is promoted directly to the consumer through a television commercial, then provision must be made to assure that the consumer can obtain substantial additional information needed to assess the benefits and risks of the product. Under an FDA guidance issued in August 1999, this requirement can be met through four mechanisms an 800 number that the consumer can call to ask that the information be mailed or read referral to an internet site information in an advertisement in a current issue of a magazine or materials that can be obtained from a health care provider. ... 

To start a referral procedure different forms must be used, according to the type of referral such forms are annexed to the Guideline included in the Notice to Applicant Volume 2A - Procedures for Marketing Authorization - Chapter 3 - Community Referral - February 2004. 

All the above are criteria for referral to a doctor and form part of the licensing conditions for non-prescription sale of azole anticandidal treatments. 

When the carbon monoxide molecule dissociates upon adsorption, it is referr to as the dissociative adsorption of carbon monoxide. As in the case of molt ulor adsorption, the rate of adsorption is proportional to the pressure of carb< monoxide in ihe system because this rate is governed by the number of g eous collisions with the surface. For a molecule to dissociate as it adsort however, two adjacent vacant active sites are requited rather than the sing site needed when a substance adsorbs in its molecular form. The probability... 

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