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Hooper Referral Form.pdf

HooperAppointmentReferralPacket_2020fillable.pdf
Preview of Hooper Referral Form
🔗 Source: centralcityconcern.org
📊 Size: 424 KB
📄 Pages: 4 pages
⬇️ Downloads: 103

Summary

Appointments are available Monday through Friday, 8:00 AM - 1:00 PM, with patients asked to arrive 30 minutes early. A 10-day supply of medications in original packaging is required, but controlled substances are not allowed unless intended for destruction. Referring providers must fill out attached forms and email them to [email protected] to schedule an appointment. Patient information, contact details, substance use history, and medical information are required. An authorization form for the use and release of protected health information must also be completed.

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Description

Appointments are available Monday through Friday, 8:00 AM - 1:00 PM, with patients asked to arrive 30 minutes early.

Technical Information

  • File Format: PDF
  • File Size: 424 KB
  • Pages: 4
  • Language: EN
  • Total Downloads: 103
  • Last Updated: 3 months ago

Document Overview

This PDF document about Hooper Referral Form provides comprehensive information and guidance. Whether you're a beginner or advanced user, this resource offers valuable insights into Hooper Referral Form.

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