It is important that practices use consultation and transfer of care request forms. Practices may want to adopt a form used by managed care organizations or develop their own. To make certain that the intent of the referral is clear, 2 separate forms may be used; one for consultations and one for a transfer of care. However, if your practice decides to adopt just one form, make certain that the form clearly differentiates the reason for the referral. Make certain that the form is understood by each physician or appropriate source that refers patients into or out of your practice. Keep a copy of the form in the patient’s medical record and encourage the referring physician to also maintain a copy in his or her records.

The form(s) should include the following information:

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