Doctor Referral Forms

April 9, 2019

In medical practice, it is quite common that patients are shifted from one medical facility to another. This especially depends on the nature of the health facility and the doctor’s level of expertise.

When does a patient need to be referred?

For example, suppose a midwife sitting in a far-off, remote area of the country encounters a laboring patient with full-blown eclampsia. In that case, she needs to refer this patient to a tertiary care hospital for better management and delivery of the baby.

Similarly, if a junior doctor faces a severe road traffic accident in the local dispensary, he needs to refer such a patient to tertiary care after providing first aid.

So, referring a patient from one place to another is a common practice, and doctors are always exchanging patients so that the right healthy facility comes into contact with the patient.

Specialists Referral Form

Physical Therapy Referral Form

Psychiatric/Psychology Referral Form

Occupational Therapy Referral Form

Radiology Referral Form

Surgery Referral Form

Home Health Care Referral Form

Surgery Referral Form

How is a patient referred?

There is a proper method for every action taken in the medical sciences, even in cases of emergencies. One has to follow proper protocol while referring a patient from one place to another. We can’t just verbally tell the attendants about the critical condition of the patient and cannot advise them to take them to a better health facility.

You have to make a proper referral form, mention all the current situations and advice, and sign it properly. Good healthcare facilities also provide an ambulance to transfer the patient out.

Hospice Referral Form

Hospice Referral Form

Doctor referral form

The first and foremost thing on a referral form is the complete name of the doctor, his contact number, and his address. It is really important because we want to send the patient to the right doctor in the safest possible time.
The date is also mentioned with time to show when the patient was attended to and how much time was spent in the primary health care center to get the idea of delay or prompt management. This is critical in the case of the management of emergencies. Every second counts, literally.
Then we have to mention the information about the patient. The name of the patient, his medical record number, his age, sex, and contact number are written in the beginning.
Then we mention details about the patient’s complaints when he reached the first doctor. His presenting complaints and his past medical and surgical history are mentioned. If there is anything significant in his allergy, drug, or transfusion history, that is also mentioned in the form to give a whole lot of information.
The examination done at the time of admission is also important, as is any treatment provided.
A differential diagnosis or final diagnosis, if made, is written at the end, and we also mention the reason why we are referring this patient to another doctor. Emergency or no emergency, we have to write the reason for referral to another doctor.
In the end, the doctor who is referring the patient can write his comments, if any. Treatment is especially given at his place, and his vitals and general condition improve after the treatment is given.

Sample

Doctor Referral Form

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