Initial Medical Referral Form: Rehabilitation

Form Template

To get a medical referral, a patient must meet with a health care provider, such as a primary care physician or a physician's assistant.

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The referral specialist will then take care of any remaining items needed to get the patient to the referred facility.

The Initial Medical Referral Form mobile app helps capture patient information needed to direct him/her to the appropriate facility. The medical referral form contains information on the applicant, diagnosis, injury, treatment and space for additional notes.

The Initial Medical Referral Form is an easy-to-use mobile app that can be completed from any desktop or mobile device. This is a great way to make sure all information is properly collected for patient to move to the next medical center.

Whether you work in administration for referral services or are a referral specialist, you can move patient transfers along more quickly with this convenient app.

  • Submission Editing
  • Reference Data
  • Dispatch
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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