Name: ________________________________________
Date: _________________________________________
Procedure 9-3:
Arranging a Referral Appointment
Objective: Schedule a referral appointment for the patient.
Equipment and Supplies: Patient chart; telephone; paper; pen; either Rolodex or physician
directory; and physician request for referral information
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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1. Gather supplies.
2. Open the patient chart, and review
the insurance information and
physician request for referral.
3. Place a call to the physician’s
oce to whom the patient is
being referred.
4. Identify yourself and the
physician on whose behalf you
are calling. Let the oce know
you are calling to schedule a
referral appointment.
5. First, verify that the practice
accepts the patient’s medical
insurance. If so, continue with the
call and provide necessary patient
information. If the oce does not
accept the patient’s insurance,
thank the practice for its time
and notify the physician. The
physician will then recommend
another physician for the patient
referral.
6. If the oce accepts the patient’s
insurance, provide the following
information: patient’s name,
address, telephone number, and
reason for referral.
7. The oce may ask how soon the
patient needs to be seen and will
then schedule the patient.
8. Record the referral appointment
information in the patient’s
chart as well as on an
appointment reminder card for
the patient.
Name: ________________________________________
Date: _________________________________________
POINT VALUE
= 3–6 points
= 7–9 points
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NOTES
9. Be sure also to record the name
of the individual with whom you
spoke and the creation of the
reminder card.
10. Notify the patient of the
date and time of the
appointment, and provide the
reminder card.
11. Verify that the patient
knows the oce location. If
not, provide clearly written
directions.
12. Forward any pertinent information
such as laboratory tests or X-rays
to the physician’s oce, and
record them in the patient’s chart.
If faxing information, be sure to
place the fax confirmation in the
patient’s chart.
13. If precertification is required,
contact the patient’s insurance
company and request
authorization. Depending
on the insurance carrier,
this may be done either by
computer, telephone, or fax.
The insurance company will
require the following information:
specialist’s name, telephone
number, and reason for the visit
or request.
14. If completing the precertification
by telephone, document the
precertification number and the
name and telephone number of
the individual who provides the
number.
Name: ________________________________________
Date: _________________________________________
POINT VALUE
= 3–6 points
= 7–9 points
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15. Provide the precertification
number and pertinent information
to the physician’s oce to which
the patient is being referred.
GRADING
Points Earned
Points Possible 105 105
Percent Grade (Points Earned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
Name: ________________________________________
Date: _________________________________________
POINT VALUE
= 3–6 points
= 7–9 points
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