referrrals
Additional Information for Providers
Please fax (828-372-4580) or email (kim@coopernp.com) the following information:
Referred by:
- Name
- Organization
- Contact phone & email
Client info:
- Client's full name (and preferred name if applicable)
- Date of birth
- Phone
- Full address
Emergency Contact and/or Legal Guardian:
- Name
- Relationship
- Phone
Also include:
- Reason for referral
- Current medication list
- Most recent H&P, relevant progress notes, discharge summary
- Photos of front & back of insurance card (if client will be using insurance)
