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Consultation Request Form for Health Nucleus Clients
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To request a specialist consultation for a Health Nucleus client, please take the time to fill out the information below.
Client's HN person number
First Name
Last Name
A short summary of reason for consultation
Client's City
*
Client in San Diego
Client in other city
Requested diseases or conditions
Requested specialties (one or more specialties can be requested)
Any symptoms that patient is currently experiencing
Internal or external referral
*
External - MGH
Internal - HN
External - Cedars Sinai
External - UCSD
External - Other
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