Referring Providers

Dear Referring Providers:
Thank you for allowing MedSport to participate in the care of your patient. We are dedicated to providing exceptional service and care to you and your patient.

To help us care for your patient, we kindly request that you provide the following information to our care team and patients:

– Relevant patient information, including:

• Patient Name
• Date of Birth
• Address
• Phone Number

– Preliminary diagnosis

• Include relevant medical records and operative notes for any prior procedures in the affected area within the last 5 years
• X-Ray or Imaging Studies, including MRI and/or CT Scan (if applicable) related to your patients’ orthopaedic condition(s). Please do not have the patient only bring the X-Ray or Imaging study report, since having the actual X-Ray or Diagnostic Imaging study allows our providers to perform a comprehensive assessment of your patient’s condition and develop an optimal plan of care.

– Referring Provider’s name with phone & fax number

– Patient’s health insurance information / IPA or medical group (if applicable) / Third

 party payer information

We appreciate you taking the time to refer your patient to us.

Sincerely,
MedSport Providers and Staff