Make a Referral

Send a patient to the right Nakasero specialist. Tell us who you are, who you’re referring, and the clinical picture — we’ll take it from there.

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Name

First

Last

Alt Email

Phone

Alt Phone

Name

First

Last

Sex Email

Alt Email

Phone

Alt Phone

Sex

Date of birth

Send the patient a copy of referral updates and correspondence.

Major complaint

Medical & family history

Diagnosis of referring doctor

Symptoms

Referring doctor's comments

Any other information

Supporting Documents

Drag & Drop Files, Choose Files to Upload

Upload supporting documents if any
Lab results, imaging, prior notes · PDF, JPG, PNG up to 25MB

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