Follow the steps to complete the Dietitian Referral Form Template online:

1. Click the ‘Get Form’ button to obtain the Dietitian Referral Form Template and open it in your editor.
2. Begin with the facility information section. Fill in your facility's name, business telephone number, address, and email address. Make sure this information is correct and up to date.
3. Next, provide the applicant’s name and telephone number. This person will be the primary contact for this referral.
4. In section A, check the appropriate boxes that apply to your facility regarding staffing qualifications and the number of persons in care. Review the requirements carefully to ensure compliance.
5. If applicable, submit the necessary documentation listed in section A, such as the meal cycle, completed menu audit, and nutritional policies. Ensure everything is included.
6. Continue to section B, where you will provide the reason for the referral, selecting from the options provided. Clearly indicate if this is for a new facility, long-term care, or other specified reasons.
7. For section C, if tube-feeding is required, confirm that a Registered Dietitian is included in your staffing plan, as noted.
8. At the end of the form, the Licensing Registered Dietitian will have space to approve or comment on the referral. Ensure that the approver’s signature and the date are included.
9. Finally, review your completed form for any errors or omissions before saving any changes, downloading a copy, or sharing it as needed.

Complete your forms online to ensure compliance and streamline your referral process.