Referral Checklist
By referring patients requiring wound care services to our team, we can work collaboratively to enhance their recovery process.
Once you have identified a potential patient appropriate for consult/evaluation and treatment, you must submit the following documentations.
We only need a few pieces of required documentation to start processing a referral.
-
Face sheet/Patient’s demographics (Required)
-
Signed physician/PA/NP order (Required)
-
Insurance information (Required)
-
Include any family members who should be contacted for appointment scheduling (Optional)
OTHER HELPFUL DOCUMENTATION
This information is extremely helpful and allows our team to more efficiently process the referral.
-
Wound Photos
-
History and Physical
-
Any recent progress notes, if available
You can choose how to submit the documents whether through our email, fax, or online referral portal.
Please note that if you submit through our email and fax, you do not need to fill out the online referral form.
*Surgical wounds created in the last 90 days must have an order from the surgeon approving West Coast Wound to evaluate and treat due to a 90-day global period.
