Ttts Siugr Referral Form – Fill Out and Use This PDF

Ttts Siugr Referral Form PDF Details

In an effort to streamline and enhance the management and treatment of complex fetal conditions, the University of Miami/Jackson Memorial Hospital Fetal Therapy Center has developed a comprehensive referral form designed for Twin Twin Transfusion Syndrome (TTTS) and Selective Intrauterine Growth Retardation (SIUGR). This meticulously crafted form serves as a critical tool for gathering detailed patient information, which includes personal and insurance details, as well as extensive medical information related to the pregnancy and the specific conditions being referred for. It covers a broad spectrum of data collection, starting from basic patient identification like name, date of birth, and contact information, to more detailed medical histories involving prenatal records, lab results, and ultrasound reports. Physicians are required to provide their contact information, further illustrating the collaboration needed in managing these high-risk pregnancies. Additionally, the form delves into the technical aspects of TTTS and SIUGR, asking for specific information about the twins' conditions, such as amniotic fluid discrepancies, placental location, and doppler studies, among others. Designed for efficiency, the form includes sections for insurance verification to assist in the smooth processing of the patient's referral. It emphasizes the necessity of a comprehensive approach to fetal care, aiming to facilitate prompt and accurate communication between referring physicians and the specialized care team at the Fetal Therapy Center.