Pediatric Urgent Care to PICU Referral Form

Streamline Critical Pediatric Transfers with a Structured PICU Referral Form

When a pediatric patient in urgent care requires intensive care, every second counts. This Pediatric Urgent Care to PICU Referral Form provides healthcare teams with a structured, efficient way to communicate critical patient information, coordinate interfacility transfers, and ensure continuity of care during urgent escalations.

Designed for pediatric urgent care centers, emergency departments, and community hospitals, this form template captures essential clinical data including respiratory distress assessments, dehydration severity scores, vital signs, and critical illness screening criteria. By standardizing the referral process, your team can reduce communication errors, expedite acceptance decisions, and improve patient outcomes.

Built for Healthcare Workflows

This template includes conditional logic to reveal relevant assessment sections based on presenting complaints, ensuring clinicians only complete pertinent fields. The form captures:

• Patient demographics and insurance information
• Current vital signs and clinical presentation
• Respiratory distress assessment tools
• Dehydration severity scoring
• Critical illness screening criteria
• Current interventions and response
• Laboratory and diagnostic results
• Transfer logistics and accepting facility details

Paperform's healthcare-focused features make it ideal for medical referral workflows. Connect your form to your EMR system via Stepper (stepper.io) to automatically update patient records, trigger notification workflows to transport teams, and maintain HIPAA-compliant documentation trails. The platform is SOC 2 Type II compliant and offers data residency controls to meet healthcare data security requirements.

Improve Care Coordination

For pediatric healthcare providers managing interfacility transfers, clear communication can mean the difference between timely intervention and delayed care. This template helps urgent care physicians, nurse practitioners, and transfer coordinators present complete clinical pictures to receiving PICU teams, facilitating faster acceptance decisions and appropriate preparation for incoming patients.

Whether you're a pediatric urgent care network, community hospital with pediatric services, or children's hospital coordinating regional transfers, this form template provides the clinical structure and workflow automation to make critical referrals smoother and safer.