ReferralRight

Refer a patient to a dentist

Fill the referral. Nothing is sent until you sign.

Fill what you know. Nothing sends until you sign.

The referral

Patient

Date of birth

Procedure date

Qualifying condition

Clinical rationale

This has to be your words or the note’s. It is the clinical link.

Gender

Phone

Address

ICD-10 codes

Does the patient have teeth?

If you know. A referral for an edentulous patient is the commonest wasted visit.

Send to

Your details, asked once

Your legal name

Credential

Referring physician

Their Medicare PIN

Fax for the returned report

Or email for the returned report

This referral keeps its own copy of what was true when you sent it. To be asked once instead of every time, make a free account. You do not need one to send this.

I, the signer named on this account, attest that this information is accurate and that I am authorized to make this clinical referral.

Not signed in.

Check every field against the note. You are signing that it is accurate.

Referrals needing attention · Plain form if this screen ever fails to load.