Risk Management

Referral Form for Patient and Physician

When you refer your patient to another healthcare provider (particularly for urgent or emergent situations or lab work), we suggest that you send a referral request to the provider and give the patient (family member, caregiver etc.) a written document with details regarding the referral. This recommendation is based on several major lawsuits OMIC has litigated where the patient has denied being referred for a consultation, even when there was a clear note in the patient’s chart that such a referral was made. We have been able to successfully defend some of these cases, others we have had to settle. However, regardless of the outcome, it was clear the cases were more difficult to defend because of the lack of evidence the patient received written documentation of their condition and the urgency of the referral.

Download a copy of the referral form to send to the other physician by clicking here: Referral Note to MD.

Download a copy of the referral form by clicking here: Referral Note for Patient

The sample referral note is an example of what OMIC considers important information to provide to the patient. This is simply a recommendation and does not constitute a standard of care. You will want to modify the referral note to best meet your patient’s specific needs.

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OMIC is the largest insurer of ophthalmologists in the United States and we've been the only physician-owned carrier to continuously offer coverage in all states since 1987. Our fully portable policy can be taken with you wherever you practice. Should you move to a new state or territory, you're covered without the cost or headache of applying for new coverage.