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What should you enclose with the referral of the patient?

What is the patient's name?

What is the patient's date of birth?

Do you have a copy of his or her identity card?

What is the patient's permanent mailing address?

How long has he or she lived at this location?

What was the mailing address of the patient from birth until now?

Is there anyone who knows him or her?

How long have you known him or her?

What do you know about him or her?

Can you comment about his or her character, behavior, and competence?

Does he or she lie?

What languages can the patient speak and write?

What is the patient's race?

Has the patient been referred by anyone?

Who has referred the patient?

Conscious means able to see, hear, and talk.

In pediatric patients younger than six months of age, the ability to make any verbal noise or cry is equivalent to talking.

Where is the patient the day you are writing this document?