Primary Care to Accountable Health Community Referral Form

Streamline Cross-Sector Patient Referrals with Whole-Person Care Integration

Managing patient referrals across medical, behavioral health, and social service sectors requires coordination that goes far beyond traditional specialist referrals. This Primary Care to Accountable Health Community Referral Form template is designed for healthcare providers, community health centers, and integrated care networks who need to support population health initiatives through seamless cross-sector collaboration.

Built for Value-Based Care and Social Determinants of Health

Modern healthcare delivery recognizes that clinical care alone doesn't determine patient outcomes. This referral form captures the full spectrum of patient needs—from specialist medical care and behavioral health services to food security, housing stability, transportation access, and care coordination support. It's ideal for accountable care organizations (ACOs), patient-centered medical homes (PCMHs), federally qualified health centers (FQHCs), and health systems implementing community-based care models.

Coordinate Care Across Multiple Touchpoints

The form guides referring providers through a structured assessment that identifies medical complexity, behavioral health concerns, social determinants of health, and care coordination needs. Built-in conditional logic ensures that only relevant sections appear based on referral type, reducing form fatigue while capturing critical information for receiving providers and community partners.

With Paperform's calculation and conditional logic capabilities, you can route referrals to appropriate care teams, trigger different follow-up workflows based on urgency levels, and ensure that complex cases receive the multi-disciplinary attention they require.

Automate Referral Workflows with Stepper

Connect this form to Stepper to create intelligent referral workflows that notify the right care teams, update your EHR or care management platform, and track referral completion rates. You can automatically route behavioral health referrals to integrated mental health teams, social care referrals to community health workers, and urgent cases to care coordinators—all while maintaining HIPAA-compliant documentation trails.

Designed for Healthcare Teams Who Value Efficiency

Primary care providers, care coordinators, and community health workers need tools that support their workflow without adding administrative burden. This template balances comprehensive data collection with user-friendly design, helping busy clinical teams make warm handoffs to community partners while meeting quality reporting requirements for value-based care contracts.

Paperform is SOC 2 Type II compliant and trusted by healthcare organizations worldwide. Start with this template and customize it to match your accountable health community's specific referral protocols, partner networks, and population health priorities.