Referral Request AP

Referral for this condition was [select name="Ref" value="|renewed |placed as new consult |not renewed |not warranted "][conditional field="Ref" condition="(Ref).is('renewed ')"]for [select value="|Neurologist|Sleep Medicine Specialist|Psychiatrist|Psychologist|Ophthalmologist|Otolaryngologist/ENT|Oral Surgeon|Cardiologist|Pulmonologist|General Surgeon|Gastroenterologist|Nephrologist|Urologist|Obstetrician|Gynecologist|Orthopedist|Pain Management Specialist|Physical Therapist|Chiropractor|Hematologist|Oncologist|Endocrinologist|Rheumatologist|Dermatologist|Plastic Surgeon"] in the local area. It was felt that this specialties services are value-added in assisting family medicine in managing patient's complex issues surrounding this condition. The specific aspects we request they continue to evaluate/treat include: [text size="80"].[/conditional][conditional field="Ref" condition="(Ref).is('placed as new consult ')"]for [select value="|Neurologist|Sleep Medicine Specialist|Psychiatrist|Psychologist|Ophthalmologist|Otolaryngologist/ENT|Oral Surgeon|Cardiologist|Pulmonologist|General Surgeon|Gastroenterologist|Nephrologist|Urologist|Obstetrician|Gynecologist|Orthopedist|Pain Management Specialist|Physical Therapist|Chiropractor|Hematologist|Oncologist|Endocrinologist|Rheumatologist|Dermatologist|Plastic Surgeon"] in the local area to re-establish care, since patient [select value="no longer lives near her previous specialist|no longer has a therapeutic relationship with current one and/or desires 2nd opinion"]. The specific aspects we are requesting they evaluate/treat include: [text size="80"].[/conditional][conditional field="Ref" condition="(Ref).is('not renewed ')"]for [select value="|Neurologist|Sleep Medicine Specialist|Psychiatrist|Psychologist|Ophthalmologist|Otolaryngologist/ENT|Oral Surgeon|Cardiologist|Pulmonologist|General Surgeon|Gastroenterologist|Nephrologist|Urologist|Obstetrician|Gynecologist|Orthopedist|Pain Management Specialist|Physical Therapist|Chiropractor|Hematologist|Oncologist|Endocrinologist|Rheumatologist|Dermatologist|Plastic Surgeon"] as this specific specialty's services no longer warranted. Care for this condition can be provided within Family Medicine. Patient agreeable for this. Care for this condition will include: [textarea rows="3"].[/conditional][conditional field="Ref" condition="(Ref).is('not warranted ')"]and, using shared decision-making, patient agreed/amenable to trial of management of this condition within family medicine. Care for this condition will include: [textarea rows="3"].[/conditional]