The following checklist describes the information we require when referring a patient. Please be prepared with this information when you contact RSA Medical.
Your contact information:
Information about your patient:
Your patient's complete medical history and records:
Description of your patient's current medications:
Diagnostic Test reports plus actual films or tracings:
Your contact information:
- Name
- Address
- Phone number
- Fax number
Information about your patient:
- Name
- Birth date
- Address
- Phone number
- Social security number
- Insurance information
Your patient's complete medical history and records:
- Medical history
- Surgeries/procedures
- Devices: type/settings
Description of your patient's current medications:
- Type(s)
- Dosages
- Allergies
Diagnostic Test reports plus actual films or tracings:
- Cardiac catheterization: actual film plus report
- Echocardiogram: actual tape plus report
- Thallium stress test: actual x-ray film plus report
- Chest X-ray, CT scans, ultrasounds: X-ray films plus report
- Electrocardiograms: actual tracings if available
- Electrophysiology testing: actual tracings and reports
- Any and all blood studies
- Any other relevant testing and/or results