Hospital Referral Form Template

Doctors often refer patients to other doctors when they learn that treating the patient does not lie in their area of practice. The purpose of referring is to make sure that the patient gets the right treatment from the right healthcare professional and does not face any inconvenience during the treatment.

What is a hospital referral form?

A hospital referral form is a tool that is used by medical experts when they want to refer a patient to another doctor. This usually happens when the patient is getting the treatment from a primary healthcare professional and after a series of diagnostic tests, the doctor has come to know that the patient needs to be treated by a specialist doctor.

The specific department of the medical care facility uses this form sometimes so that the patient can be redirected to another healthcare practitioner for further treatment, evaluation, and diagnosis. This referral form is very useful as its main objective is to make sure that the patient gets appropriate care.

What are the sections of the referral form to be used in the hospital?

The details included in this form involve those elements that a medical specialist needs to proceed with the treatment of the patient. Here are some basic elements:

Basic information about the patient

The doctor who is being sent this form should know about the patient such as name, gender, date of birth, ethnicity, residence state, etc.

Information of the primary physician

The information about the physician who is currently treating the patient and is going to refer the patient to another doctor should be mentioned in this form. This lets the recommended doctor see where the patient got the treatment initially. The information usually includes the name, area of practice, department, specialty, etc.

Information about the doctor being referred

In this part, the primary physician tells where the doctor belongs and what his expertise is. The details of the license as well as contact details are also provided so that the patient can contact the doctor if he is unable to access him physically.

Reasons for referring

Here, it is the responsibility of the primary physician to mention the reasons for which he has decided to treat the patient any further and wants the patient to get better treatment that is available with the physician he is referring to. The reasons are for the doctor who is going to treat the patient. These reasons help him understand the actual cause of why the primary physician refused to carry on the treatment and decided to refer him to another doctor.

Consent of the patient

There is a separate section in the form in which the patient is asked to give consent so that it can ensure that treatment is being initiated at a new healthcare facility or with a new doctor with the permission of the patient. Sometimes, the consent statement is already written and the patients are required to put their signatures only. 

Signatures of the primary physician

The form contains many details that are provided by the primary physician. However, there is no proof that the physician himself filled the form unless he chooses to sign it and bring it into the legal form. The person or hospital who receives this form can also confirm that it has come from the right source.

What to do after filling out the referral form?

Once the form has been filled, the doctor sends this document either to the hospital where the information provided will be processed or to the doctor directly who has been referred through the form. The purpose of sending this document is to make sure that the right details of the right person have reached the right physician and that the treatment can proceed without any trouble.

It is important to remember that this form facilitates effective communication between the two doctors and two hospitals. In case the referred doctor does not understand anything or requires more information, he can get the contact details from the form and contact the primary doctor who usually has all the details recorded in his database. Due to quick communication, things become easy for everyone. 

Hospital referral form template

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