Urgent Cardiac Consult Request

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Print Design Brief

We need a one page (1/2 pg size) order form for Urgent Cardiac Consults so that Emergency depts and walk -in clinics can fill this out and send forms with patient to our office. The page needs to have clear information, easy to read and to fill out. Our logo and address at the top and on the back side a map showing our location. I am sending a version that I have but the doctors want something different in the way of layout.
They want less information on them. At top - options for exam s: Excercise Stress Echo; Echocardiogram; Holter/Loop recorder (3day / 14 day/ other __); Concsult. Pt info in middle . Bottom : Indication s 1) Chest Pain/SOB 2: Palpatations 3) Other_____ Eyecatching, larger logo, etc Thanks


Files
PDF
19-WHEART-001-01 Referral_Form.pdf
Friday, November 22, 2019