PDF-UNC Hospitals Neurology Clinic Referral Form

Date of Request This form is a fillable PDF Please PATIENT INFORMATION Please complete the following or include demographics pageMailing Address State Preferred Phone Secondary Phone Insuran. Recent research using functional brain imaging in human subjects has begun to reveal neural substrates by which sensory processing and attention can be modulated by the affective signi64257cance of stimuli The amygdala plays a crucial role in provid Coordinated Entry. Non-WISP Referral Form. Carrie Poser, COC Coordinator. Jesse Dirkman, ICA. March . 14, . 2016. Agenda. Overview. The referral process. The Non-WISP Referral Form. Where does the information go? . N. Picardo-Green, S. . Jaufuraully. , . U. Ashraf, A. Carlos. February 2015. BOAST guidelines. BOAST 1 -Patients sustaining a fragility hip fracture . BOAST 2 - Spinal clearance in the trauma patient . Current Climate. Transition to Single Service Desk. Fewer questions at “ref desk”. Changing nature of questions less reliance on subject expertise. Tiered referral model. Referral Methods. Old. S. Lee Woods, M.D., Ph.D.. Director, Office of Surveillance and Quality Initiatives. Maternal and Child Health Bureau. Prevention and Health Promotion Administration. Maryland Department of Health and Mental Hygiene. Neurodegenerative Disorders. Michael Babcock. Summer 2013. Scenario. -2 yo female. -parents bring child to clinic due to speech concerns. -does not say any words. -he sat at 7 months, began walking at 16 months, though has not walked for last 2 months. Managing Headache Headache is an increasing problem Figures for specific CCGs available at: https:// www.gov.uk/government/publications/neurology-services-hospital-activity-data 24% increase in those in treatment for headaches and migraine in the past 5 years AUCTION DATE Per ederal regulations and state policies referrals should be made as soon as possible but not later than seven 7 days after determining an infant toddler or child is in possible need of services Date Patient informationFirstnameLast NameGenderMF OtherRaceDateof Birth//SSLanguageEthnicityThese prompts are required by federal government rules and regulations HomeAddressCityStateZipEmailAddressOc Julie Teraci. Clinical Nurse Consultant / Nurse Coordinator.. WAKMAS. Clinic. MDT. Referral criteria for clinic appointment. Confirmed histopathological diagnosis of melanoma . Patients with a melanoma ≥ 0.8mm Breslow thickness. Dr Niamh Lynch and Professor Ronan O’Sullivan. Bon Secours Hospital, Cork. Case 1. ‘Dear Dr Lynch, Patrick is a fourteen-year-old boy who sustained a head injury whilst playing a GAA match last weekend. He had dizziness, confusion and vomiting immediately afterwards. He was brought to the local emergency department, and was observed for several hours. He was discharged home with head injury advice. Since then he complains of an increasing headache, photophobia, and dizziness. Your urgent review would be much appreciated.’. Bromley . Greenwich. Lewisham . Yes . Refer to Guy’s and St. Thomas Cardiac Rehabilitation . Refer to My Time Active Fresh Start/ Heart Smart . My Time Active Referral Form submitted to email address on top of form . 1-8. 55. -. 374. -. 3497. . Write . LTC+ URGENT . on the top left . corner . Include reason for imaging on the requisition . - Rule/out fraction. . - Level of concern . All . exams marked as URGENT will be .