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Form 940 (Schedule R) online Carrollton Texas: What You Should Know
Jennifer C. Pukka; Dr. Nazi T. Nazi; Dr. Khan Y. High; Dr. M. S. Patel. Please enter a patient's name. Enter a description of patient. Enter in patient's date of birth. Enter in date of surgery. Enter in patient's physician's name. Enter the specialty name or specialties. Choose the date of surgery. Enter in number of patients. Leave a note about number of patients you refer. Enter the location of patient(location code 1) for the Referral Form. Enter the patient's telephone(phone number 1) for the Referral Form. Option: Enter the patient's mobile number for the referrer's mobile number. Option2: Leave the mobile number field blank and enter the patient's own mobile number. Leave the other fields blank to complete the referral form. Fill in the other fields only for reference and the physician must enter all information. A. The physician must enter both the patient's first and last name. B. The physician must enter the phone number that the referring physician uses for the patient to call. C. Patient's telephone number must be a permanent phone number and not a temporary phone number. D. If you have more than 30 patients, select an option to have the physician enter the patient's first and last name for each of the patients in your office's list of patients. E. Provide the patient's contact phone number that the referring physician uses for the patient. F. The patient's current fax number is required if you are offering in-office faxes to the patient. G. If you are sending an email to the patient, provide the patient's phone number.
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