---
title: Specialty Pharmacy Referral Form Template for Care Managers | Paperform
description: Streamline specialty medication referrals with this comprehensive form template for health plan care managers, featuring prior authorization support, patient assistance screening, and medication management coordination.
url: "https://paperform.co/templates/specialty-pharmacy-referral-form"
type: static
generatedAt: "2026-03-28T00:45:14.600Z"
---

[← Back to free form templates](/templates/)    ![Specialty Pharmacy Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/specialty-pharmacy-referral-form.png)
    [Preview](https://_preview.paperform.co/ai-template/specialty-pharmacy-referral-form) [Use this template for free](/create?ai-template=specialty-pharmacy-referral-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Simplify Specialty Pharmacy Referrals with Paperform

For healthcare organizations, care management teams, and specialty pharmacies, coordinating high-cost specialty medications requires detailed documentation, prior authorization support, and seamless communication between providers. This **Specialty Pharmacy Referral Form** template is designed to capture all the critical information needed to ensure patients receive appropriate specialty medication management while streamlining the complex referral process.

#### Built for Healthcare Care Management Workflows

Whether you're a health plan care manager, case manager, or specialty pharmacy intake coordinator, this form template helps you collect comprehensive patient demographics, clinical information, prescription details, insurance verification, and prior authorization requirements—all in one structured submission. The form includes sections for medication details, diagnosis codes, prescriber information, and patient assistance program eligibility screening.

With Paperform's conditional logic, you can show or hide relevant sections based on medication type, insurance coverage, or prior authorization status, ensuring respondents only see questions relevant to their specific situation. The clean, professional layout makes it easy for care managers to complete referrals quickly while maintaining accuracy and compliance.

#### Integrate with Your Healthcare Systems

Connect your specialty pharmacy referral forms directly to your existing healthcare workflow tools using Paperform's native integrations or **[Stepper](https://stepper.io)**, Paperform's AI-native workflow automation platform. Automatically route referrals to the appropriate specialty pharmacy partner, trigger prior authorization workflows, send notifications to care teams, and update your EHR or care management platform—all without manual data entry.

Paperform is **SOC 2 Type II compliant** with robust security controls, making it a trusted solution for healthcare organizations that need to protect sensitive patient information while maintaining operational efficiency. With customizable success messages, automated confirmation emails, and submission tracking, your team stays informed throughout the entire referral process.

This template is ideal for managed care organizations, health plans, hospital case management departments, specialty pharmacies, and any healthcare provider coordinating complex specialty medication management for patients requiring high-cost drug therapies.
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