Telehealth to In-Person Referral Form

Streamline Your Telehealth-to-In-Person Referral Process

As telehealth continues to play a vital role in modern healthcare delivery, knowing when to transition a patient from virtual care to in-person evaluation is critical. This Telehealth to In-Person Referral Form template helps triage nurses, telehealth coordinators, and healthcare providers document the clinical rationale for referring patients to face-to-face assessment.

Built for Modern Healthcare Workflows

This template is designed specifically for healthcare practices, urgent care centers, hospital systems, and telehealth providers who need to maintain continuity of care while documenting the limitations of virtual assessment. The form captures essential information including:

• Virtual assessment limitations that necessitate in-person evaluation
• Physical examination needs that cannot be performed remotely
• Diagnostic testing requirements for proper diagnosis and treatment
• Technology barriers that impact the quality of virtual care
• Patient demographics and contact information for seamless handoff

Why Paperform for Healthcare Referrals?

Paperform makes it easy to create professional, HIPAA-friendly referral forms that integrate seamlessly into your existing healthcare workflows. While this form collects patient information, you can enhance your compliance posture by connecting submissions to your secure EMR/EHR systems through Stepper (stepper.io)—Paperform's AI-native workflow automation tool.

With Stepper, you can automatically route referrals to the appropriate specialists, send notifications to care coordinators, update patient records, and trigger follow-up appointment scheduling—all without manual data entry. This reduces administrative burden on nursing staff and ensures no referral falls through the cracks.

Perfect for Healthcare Teams

Whether you're a telehealth triage nurse conducting initial patient assessments, a care coordinator managing referral workflows, or a healthcare administrator optimizing virtual-to-physical care transitions, this template provides the structure you need. The form's conditional logic adapts to different referral scenarios, ensuring you capture relevant details for urgent referrals, routine follow-ups, or complex cases requiring multiple diagnostic tests.

Customize the template to match your organization's referral protocols, add your branding, and embed it directly into your telehealth platform or patient portal. With Paperform's intuitive editor, you can modify fields, adjust workflows, and maintain compliance without needing IT support.

Note: While Paperform offers robust security features including SOC 2 Type II compliance, this template is designed for general healthcare use and is not HIPAA compliant on its own. For HIPAA-compliant workflows, consult with your compliance team about appropriate safeguards and integrations.