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Hospital Referral Guidlines:
Patient Transfer Purpose:
Transferring patients to tertiary hospitals should be based on patient’s need for specialized care that is not available in the referring hospital; ineligibility for treatment in the referring hospital, or the preference of the patient.
How to arrange for hospital to hospital transfer:
All patients' referrals must be coordinated directly between the physicians in the referring facility and the accepting facility, the concerned physician in the receiving facility must accept to see the patient in the clinic prior to any other procedures.
As a physician in the referring hospital, please follow the below procedures:

  • Inform the patient or the patient’s family regarding the referral prior to any arrangements being made.
  • Complete the online form below.
  • Once you receive our acceptance letter you may inform the patient or the family.
  • Complete the referral forms and attach the needed documents, copied materials and investigations.
This form should be filled by the referring Physician.
Patient Information:
Patient Name:  
Age: Gender:
Nationality:  
Patient File# in Referring Hospital: Patient File# in Tawam Hospital:
Patient Contact #:  
Does the patient has a residence visa?
Insurance Company:  
Reason for Transfer:
History & Diagnosis:  
Current Medications the patient is useing:  
Referring Hospital Information:
Hospital Name:  
Referring Physician Name:  
Referring Physician Speciality:  
Referring Physician Mobile#:  
Referring Hospital Fax#:  
Accepting Physician Name (if contacted):
 
Once You Submit this form you will be provided with a reference number that you may use when following up on the status of the transfer request.
(the reference number is not the patient's file number)
Kindly send any lab. MRI, X-Ray, CT-Scan and Histology reports after writing the reference number on each page to Fax number: 03 707 5836