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Home / Patient
Referral |
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PATIENT REFERRAL
Patient Referral Form
Referral Form for International Patients and Referring Physicians
If you wish to be referred to a hospital of our hospital network,
please fill out the referral form below. Your form will be sent
to the appropriate hospital immediately for follow-up. You can submit
the information by pressing the send button and transmit the form
electronically.
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DATA
SECURITY AND CONSENT MESSAGE
THE BASKENT UNIVERSITY HOSPITAL NETWORK
WILL USE YOUR REFERRAL FORM TO BEGIN ARRANGING FOR CARE. THE
INFORMATION YOU PROVIDE WILL BE KEPT PRIVATE IN ACCORDANCE TO
OUR CONFIDENTIALITY POLICIES, AND WILL BE SEEN BY A LIMITED
NUMBER OF AUTHORIZED INDIVIDUALS AS NECESSARY, INCLUDING CERTAIN
HEALTH CARE PROVIDERS AND THE INTERNATIONAL PATIENT COORDINATORS.
IF YOU NEED TO CHANGE THIS INFORMATION, PLEASE CONTACT US BY
PHONE OR E-MAIL. WE MAY CONTACT YOU IF WE NEED TO VERIFY OR
OBTAIN FURTHER INFORMATION. YOU SHOULD UNDERSTAND THAT THIS
REFERRAL FORM DOES NOT ESTABLISH A DOCTOR-PATIENT RELATIONSHIP;
YOU MAY BECOME A PATIENT ONCE YOU COME TO OUR HOSPITALS FOR
INVESTIGATION OR TREATMENT. AT THAT POINT, THIS FORM WILL BECOME
PART OF YOUR MEDICAL RECORD.
THE
BUHN CANNOT ABSOLUTELY GUARANTEE THE CONFIDENTIALITY OR SECURITY
OF SUCH ELECTRONIC TRANSMISSIONS. |
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