Get Referral Request - Stanford Health Care

Completing the Referral Request form for Stanford Health Care is an essential step in ensuring seamless patient care. This guide will provide you with clear instructions to efficiently fill out the form online, making the process easier for both you and the patient.

Follow the steps to complete your Referral Request effectively.

1. Press the ‘Get Form’ button to obtain the form and access it for editing.
2. Indicate the urgency of the referral by selecting either the ‘Routine’ or ‘Urgent’ checkbox.
3. Fill in the referring provider information. Provide the referring provider's name, medical group, phone number, fax number, primary care provider, and address, including city and ZIP code.
4. Enter your details as the person completing the form, including your name and phone number.
5. Complete the patient information section. Enter the patient’s last name, first name, middle initial, date of birth, phone number, and gender. Additionally, write the patient's address, city, state, and ZIP code.
6. If applicable, indicate whether the patient needs an interpreter by selecting ‘Yes’ or ‘No’ and specifying the required language.
7. In the reason for referral section, provide the diagnosis or ICD code, the type of service or specialty requested, and the requested physician's name. You may also select if the referring provider should be contacted if the requested physician is unavailable.
8. Select the type of service requested by checking the appropriate box, such as consultation, second opinion, or surgery, and provide a specific reason for the referral.
9. Prepare to submit the required documentation to accompany the form. This may include recent and relevant clinical notes, proof of insurance, and authorization information if required.
10. Review the completed form to ensure all fields are accurately filled in. Once finalized, you can save changes, download, print, or share the form as needed.

Complete your Referral Request form online today and ensure your patient's care is prioritized.