Home Health Referral Form

Make it easy for physicians to refer patients to your home health services with this HIPAA-friendly digital form.

Simplify your workflows

Excellent home health care starts with a seamless physician referral. But too often, the process is riddled with time-consuming, paper-based processes. Eliminate the risk of missing information or illegible handwriting with this home health referral template. Our HIPAA-friendly digital form can be set up to sync directly to your health record system. Customize and upload it to your website so providers can make referrals in minutes.

Protect ePHI

Capture all the patient information you need simply and securely with this home health referral form template. Advanced form security features help you safeguard protected health information with 256-bit SSL, data encryption, and password protection. It’s the simplest, easiest way to create an online patient referral system that lets referring physicians provide social security numbers and other sensitive data without worry.

Achieve HIPAA Compliance

Because it’s designed with HIPAA compliance in mind, our home health referral form template makes it easy to meet regulatory requirements. For an even more seamless referral process, you can combine it with Formstack Documents to generate HIPAA-friendly patient documents. Secure cloud storage, file access controls, and user-level permissions all help reduce your risk of HIPAA violations, penalties, and fines.

Seamlessly sync and store

Quickly collect insurance information, Medicaid details, referral notes, and physician signatures—all in the same digital form. Then use Webhooks to send patient data to your EHR. You’ll have all the information you need to follow up on referrals from the start.

Streamline referral workflows

Reduce the need for time-consuming follow-up by using Workflows to pass the same referral form from one staff member to another. You can even combine this template with other digital forms to create a more efficient home health admissions process.

Formstack allows us to capture the data we need for regulatory bodies and to make sure patients are screened appropriately. Since launch, we’ve been at full capacity. Formstack has been a fantastic tool to help us get this off the ground.
Sarah Galyon
Operations Manager at UT Medical Center

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