Refer a patient to a physician

Fill the referral. Nothing is sent until you sign.

The referral

Patient

Date of birth

Reason for referral

What you found

Your words or the note’s. This is the observation the referral rests on.

Needed by

Optional. Leave blank if there is no date yet.

Phone

ICD-10 codes

Send to

Physician or practice name

Fax

Secure-link email

They need no account to answer. Give a fax or an email.

Your details, asked once

Your NPI

Your name

Credential

Used on this referral. To be asked once instead of every time, make a free account. You do not need one to send this.

Where the answer comes back to

Your email

Your fax

One is enough. The physician needs no account to answer, and the signed answer returns here by itself.

I, the clinician named on this account, attest that I evaluated this patient and that these are my findings.

Not signed in.

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