Primary Care to Health Information Exchange (HIE) Referral Form

Streamline Cross-Facility Medical Referrals with Health Information Exchange Integration

In today's interconnected healthcare ecosystem, coordinating patient care across multiple facilities and providers requires seamless access to longitudinal health data. This Primary Care to Health Information Exchange (HIE) Referral Form template is designed for primary care physicians, medical practices, and healthcare systems that need to query health information exchanges while initiating specialist referrals.

Built for Interoperable Healthcare Workflows

This template addresses the complex needs of modern healthcare referrals by combining patient identification verification, cross-facility records coordination, and HIE query requests into one professional, compliant workflow. Whether you're referring patients to specialists, requesting historical records from other facilities, or coordinating care transitions, this form ensures accurate patient matching and comprehensive data access.

Key use cases include:

• Primary care to specialist referrals requiring complete medical history
• Care coordination for patients with multi-facility treatment history
• Patient matching verification before record exchange
• Longitudinal health data queries for chronic disease management
• Cross-facility care transitions and continuity of care documentation

Why Healthcare Providers Choose Paperform

With Paperform, medical practices can replace fragmented referral processes—PDFs, faxes, and phone calls—with a streamlined digital workflow. The form's conditional logic ensures you capture exactly the information needed based on referral type and data requirements, while maintaining patient privacy and security standards.

The template includes built-in fields for patient demographics with matching identifiers, clinical reason for referral, requested data types, facility information, and consent documentation. After submission, you can use Stepper (stepper.io) to automate follow-up workflows: route referrals to appropriate departments, trigger HIE queries through your existing systems via API, send confirmation notifications to patients, and log submissions in your practice management software.

For practices requiring documented consent trails, Papersign (papersign.com) can transform the referral into a formal authorization document for eSignature, creating an auditable record of patient consent for information exchange.

Professional, Compliant, and Efficient

This template is optimized for healthcare administrators, medical office managers, primary care physicians, and care coordinators who need to balance efficiency with compliance. While Paperform is SOC 2 Type II compliant and trusted by healthcare practices worldwide, please note that Paperform is not HIPAA compliant, so ensure your organization's specific compliance requirements align with your chosen tools.

Create a seamless referral experience that improves care coordination, reduces administrative burden, and ensures specialists receive the complete patient picture they need for optimal treatment decisions.