Patient referral forms

Communication with other healthcare professions will include both verbal and written communication. For example, patient referral forms would be a form of written communication from the pharmacist to the prescribes These forms concern information that the pharmacist may have obtained ... 

Some patients will be seen for multiple reasons therefore, the pharmacist may need to record more than one ICD-9-CM code to fully describe the patient visit. For example, if a client with coronary artery disease (CAD) is referred to a pharmacist, it may not be uncommon that the physician requests education on lowering cholesterol through both diet and medications and education on weight loss and smoking cessation. All three conditions (CAD, obesity, and tobacco use) can be coded to represent the health conditions discussed. Example ICD-9 codes for these conditions include 414.01 (native-vessel disease), 272.2 (mixed hyperlipidemia), and 305.1 (tobacco-use disorder) (Buck and Lockyear, 2007). The specific ICD-9 code used on the claim form should be the same code used by the physician to decrease the risk of claim rejection owing to mismatched codes. Therefore, the ICD-9 code should be requested on the referral form from the physician (Snella et ah, 2004). 

Following the patient visit, a claim form (CMS 1500 or CMS 1450) is filled out and submitted to the insurance carrier. The insurance carrier may want other items before approving the claim, such as a statement of medical necessity from the referring provider and a copy of the physician s referral. A statement of medical necessity is a statement signed by the provider that states that the referral to the pharmacist (or other provider) is necessary medically (Snella et al., 2004, Poirier et al. 1999). This type of statement can be incorporated into the physician referral form (Snella, 1999). 

Dr. Brouchard develops a referral form for his service and has included fields for the physician s office to complete regarding the type ofinsurance, the policy number, the ICD-9 codes, and the physician s provider number. He plans on requesting that referring physicians complete a referral form for each patient they send to the service. If a patient approaches him directly for the service, he plans on contacting his or her physician... 

The referral form also includes check boxes for the physician to mark the appropriate ICD-9-CM codes. For diabetes education, he includes the common ICD-9 codes 250.00 (i.e., uncomplicated type 2 diabetes, controlled), 250.02 (i.e., uncomplicated type 2 diabetes, uncontrolled), and an Other field with room for the physician to add a more specific code (Buck and Lockyear, 2007). For the hyperlipidemia component, he has also included the common codes used to describe these conditions. Within the referral form is the statement of medical necessity and contact information for the physician and patients to reach the pharmacy to make appointments. Although Dr. Brouchard likes the form that he has created, he plans on revising the form based on his experience and input from the physicians office after a few months of use. He wants to make sure that the referral form is as easy to use as possible and that it contains most of the information he needs to submit claims successfully. 

Nutrition assessment is a systematic approach to collect, record, and interpret relevant data from patients, clients, family members, caregivers, emd other individuals and groups. Nutrition assessment is an ongoing, dynamic process that involves initial data collection as well as continual reassessment and analysis of the patient s/cUent s status compared to specified criteria Screening or referral form Patient/cUent interview Medical or health records... 

Medication and/or dosage changes will be made, if necessary, based on the pharmacists assessment, and patients will be counseled on these changes. The physician communication form will be used to communicate clinical recommendations regarding drug therapy. Also, patient education will be reinforced and documented. Patients will be instructed on when to return to the clinic, and referrals to physicians will occur as needed. The referrals are based on patient complications of therapy or condition and patient resistance to therapy. 

Depending on referral patterns the proportion of patients presenting with liver disease alone varies from 20 to 46%. Liver disease may mimic any forms of common liver conditions, ranging from asymptomatic transaminasania to acute hepatitis, fulminant hepatic failure (about one out of six patients with hepatic presentation), chronic hepatitis, and cirrhosis (about one out of three patients) with all of its complications. 

Guidelines have been published on the conditions for emergency department referral and prehospital care for patients who have ingested toxic amounts of valproate immediate-release or extended-release dosage forms [405 ]. 

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