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Fill Out a Referral Form

Aishwarya Nair
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External clinician can also create referrals using the referral form link configured within Practice Settings (Referral Form Templates). You can share this link directly with referral clinicians or embed it on your website, allowing clinicians to access and submit the referral form with a single click.

To learn how to Track Patient Referrals on the Referral Tracker, click here.

  • Navigate to the System Menu > select Practice Settings > Referrals > Referral Form Templates.

  • Click Copy Form Link. 

    • You can use this link for referral clinicians to provide information about their case.
  • Paste the referral form on any intended browser.
    • The referral form will appear on the new page.
  • You can click on the section labels on the top-left to quickly navigate to the desired section.
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Enter the Demographic Information:

  • Enter all the mandatory details
    • Patient Name.
    • Date of Birth.
    • Gender.
    • Phone Number.
    • Email.
  • Click Yes to contact the patient to schedule.
  • Enter the details for the Recommended Treatment.

Enter the Referral Information: 

  • Enter the mandatory details for Referring Doctor Information:
    • Referring Clinician.
    • If the Email ID is entered: 
      • The system will check for an existing referral clinician with the given Email ID and link the referral to the existing one.
      • If the Email ID of the referral clinician does not exist, the system will create a new referral clinician when the referral gets accepted.
  • Treatment Clinician Information (Tx Clinician Information):
    • Select the Preferred Treatment Location (Preferred Tx Location).
      • If the referral form has only one location, it will be selected by default. 
    • Select the Preferred Treatment Clinician (Preferred Tx Clinician).
      • By default, First Available Clinician is selected. You can select a specific provider, if required. 

  • Select the suitable Procedures and Consultations.

Under the Teeth Number section:

  • Select the teeth using the Teeth Selector.

  • Choose how you want to upload Radiographs or Clinical Photos.
    • To attach a file, select the Attach File(s) option.
  • Choose the Date of Radiograph(s).
  • Add any relevant Case Notes.

  • Click Proceed.

If you have selected the Attach File(s) option for Radiographs or Clinical Photos, 

  • Drag and drop the files on the designated area or click Browse to upload the attachment from the system.

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  • If you need to remove the uploaded attachment, click on the bin icon.
  • To print the completed referral form, click Print Form.
  • To complete the form, click Finish.
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  • You will see a message stating, 'Thank you! Your referral form submitted successfully'.
  • You can create a New Referral or Download the Submitted Form as needed.
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Practices can use this simple guide to learn how to fill out a referral form using the referral form link in CareStack.

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