Referral NR-48206 — Rosa Mendes

Received 32h ago · fax · Dr. A. Whitfield, Southside Primary Care

Reason for referral (as received)

Recurrent unexplained loss of awareness, twice this month, normal CT. Epilepsy evaluation. Meds: none. DOB 04/12/1991.

Extracted fields are AI-suggested from the de-identified text and require clinician confirmation · 1 identifiers tokenized before AI · OCR/source: fax

Recommended destination

Epilepsy

Routing confidence

90%

Missing to complete triage

Insurance / authorization infoReferring office callback number

Status

Status changes are staff actions — the referring office sees them, ending the fax black hole.

DRAFT — AWAITING STAFF APPROVAL BEFORE SEND

Missing-information request to referring office

Re: Referral NR-48206 — additional records needed to complete triage We received your neurology referral. To complete clinical triage and route this to the correct epilepsy slot, please provide: • Insurance / authorization info • Referring office callback number Once received, we expect to confirm the appointment within 2 business days. If symptoms worsen before then, please direct the patient to the nearest emergency department. — Referral Coordination