Referral Confirmation I hereby refer the above patient to West Med Medical Centre – Dr E Scott Inc for the insertion of an intrauterine device (IUD) under sedation and/or analgesia. I request that West Med Medical Centre liaise with the patient’s medical aid to obtain pre-authorisation for both the device and the procedure. I confirm that: The IUD must be ordered directly by West Med in order for medical aid benefits to apply. Only devices with a registered brand name, NAPPI code, and reference number will be eligible for cover. A detailed clinical report of the IUD insertion will be provided to me as the referring doctor for continuity of care.