---
title: Primary Care to Lipid Clinic Referral Form Template - Paperform
description: Comprehensive specialist referral form for lipid clinic evaluation. Includes familial hypercholesterolemia screening, statin intolerance assessment, cardiovascular disease history, and PCSK9 inhibitor eligibility. HIPAA-aware template for healthcare providers.
url: "https://paperform.co/templates/primary-care-to-lipid-clinic-referral-form"
type: static
generatedAt: "2026-03-28T00:44:53.163Z"
---

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### Streamline Specialist Lipid Clinic Referrals with Paperform

When patients present with complex lipid management challenges—whether familial hypercholesterolemia, statin intolerance, or cardiovascular disease despite aggressive treatment—timely specialist referral can be lifesaving. This **Primary Care to Lipid Clinic Referral Form** template helps primary care physicians, cardiologists, and healthcare administrators capture comprehensive clinical information and ensure patients reach specialized lipid clinics with all necessary context for optimal care.

#### Why This Template Matters for Healthcare Providers

Traditional referral processes often involve incomplete paper forms, faxed documents with missing pages, or fragmented electronic health record (EHR) messages that lack critical clinical detail. This creates delays in specialist evaluation, repeated phone calls for clarification, and frustration for both referring providers and patients.

Our lipid clinic referral template addresses these pain points by collecting structured clinical information including:

 - **Patient demographics and contact information** for seamless coordination
 - **Comprehensive lipid panel history** with LDL-C, HDL-C, triglycerides, and Lp(a) values
 - **Familial hypercholesterolemia screening** using validated clinical criteria
 - **Current and prior lipid-lowering therapy** including statins, ezetimibe, and PCSK9 inhibitors
 - **Statin intolerance assessment** with detailed symptom documentation
 - **Cardiovascular disease history** and risk factors
 - **Clinical urgency indicators** to prioritize high-risk patients

This structured approach ensures lipid clinic specialists receive actionable information upfront, reducing time to appointment and enabling more focused consultations.

#### Perfect for Primary Care, Cardiology, and Endocrinology Practices

Whether you're a **primary care physician** managing a panel of patients with dyslipidemia, a **cardiologist** following post-MI patients with persistent lipid abnormalities, or an **endocrinologist** treating diabetic patients with challenging lipid profiles, this template streamlines the referral workflow.

Healthcare administrators and clinic coordinators will appreciate how Paperform consolidates referral information into a clean, structured format that can be reviewed, triaged, and processed efficiently. No more deciphering handwritten forms or chasing missing lab values.

#### Built-In Features That Save Time and Reduce Errors

Paperform's conditional logic automatically shows or hides relevant sections based on clinical context. If a patient has statin intolerance, detailed symptom fields appear. If there's a family history suggesting familial hypercholesterolemia, additional screening questions surface automatically.

The form includes calculated fields for risk assessment and can be customized to match your specific lipid clinic's protocols. You can add dropdown menus that match your EHR's terminology, adjust clinical thresholds, or include additional cardiovascular risk calculators.

#### HIPAA-Compliant Data Handling

While Paperform itself is not HIPAA compliant, this template is designed with healthcare privacy best practices in mind. You can configure Paperform to work within your organization's HIPAA-compliant infrastructure by:

 - Using secure integrations with HIPAA-compliant practice management systems
 - Implementing proper Business Associate Agreements (BAAs) with all downstream tools
 - Configuring data retention and deletion policies that align with healthcare regulations
 - Restricting access through role-based permissions

For healthcare organizations requiring guaranteed HIPAA compliance, we recommend working with your IT and compliance teams to ensure proper configuration within your existing secure ecosystem.

#### Automate Your Referral Workflow with Stepper

Once a referral is submitted, manual routing and follow-up creates administrative burden. That's where **Stepper** (stepper.io) transforms your referral form into an intelligent workflow engine:

 - **Automatic triage**: Route urgent referrals (ASCVD with LDL >190 mg/dL) to expedited scheduling while standard referrals enter the regular queue
 - **EHR integration**: Push referral data directly into your lipid clinic's scheduling and documentation systems
 - **Patient notifications**: Automatically email or text patients with appointment information and pre-visit instructions
 - **Provider communication**: Send confirmation to referring physicians with expected appointment timeframes
 - **Missing information follow-up**: Trigger requests for incomplete lab work or medical records
 - **Tracking and analytics**: Monitor referral volumes, time-to-appointment, and completion rates

Stepper's AI-native workflow builder requires no coding, so practice managers and clinical coordinators can design and adjust workflows as protocols evolve.

#### Customization That Matches Your Clinical Protocols

This template provides a comprehensive starting point, but every lipid clinic has unique intake requirements. You can easily modify the form to include:

 - Your specific panel of lipid tests and reference ranges
 - Genetic testing criteria for LDLR, APOB, and PCSK9 mutations
 - Prior authorization documentation requirements for PCSK9 inhibitors
 - Inclusion criteria for clinical trials or research registries
 - Custom risk calculators (ASCVD, SCORE2, or proprietary models)

Paperform's doc-style editor makes these changes intuitive—just type, format, and add fields inline. No developer required.

#### Professional, On-Brand Clinical Forms

First impressions matter, even in healthcare. This template can be customized with your practice logo, color scheme, and typography to create a cohesive professional experience. Whether embedded in your practice website, patient portal, or sent via secure link, the form maintains a polished, trustworthy appearance that reflects the quality of care you provide.

#### Trusted by Healthcare Providers Worldwide

Paperform is trusted by over 500,000 teams globally, with SOC 2 Type II compliance, robust security features, and integration capabilities that work within complex healthcare IT environments. From solo practitioners to multi-site specialty clinics, healthcare providers rely on Paperform to modernize paper-based processes without sacrificing clinical rigor.

#### Get Started Today

Transform your lipid clinic referral process from fragmented paperwork to streamlined digital workflows. This template gives you everything needed to capture comprehensive clinical information, accelerate specialist evaluation, and ultimately improve patient outcomes in cardiovascular disease prevention and management.

Whether you're referring one patient per month or managing a high-volume referral pipeline, Paperform scales with your practice while maintaining the clinical detail that specialists need for optimal patient care.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
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