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UC Davis Health
Clinical Telehealth Program Referral Guidelines
Infant, Pediatric and Adolescent Gastroenterology
Clinical Telehealth Consultations
The following is a listing of clinical conditions
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How to fill out clinical telehealth program referral

How to fill out clinical telehealth program referral
01
Step 1: Gather all necessary information about the patient, including their full name, contact information, and medical history.
02
Step 2: Research and identify a suitable clinical telehealth program for the patient's specific needs and condition.
03
Step 3: Contact the clinical telehealth program provider and inquire about their referral process.
04
Step 4: Fill out the referral form provided by the clinical telehealth program provider. Make sure to provide accurate and detailed information about the patient's condition and any specific requirements.
05
Step 5: Submit the completed referral form to the clinical telehealth program provider through the specified channels, which may include email, fax, or an online portal.
06
Step 6: Follow up with the clinical telehealth program provider to ensure that the referral has been received and processed.
07
Step 7: Communicate with the patient about the status of their referral and provide them with any additional instructions or information they may need.
08
Step 8: Monitor the patient's progress and coordinate with the clinical telehealth program provider as necessary.
Who needs clinical telehealth program referral?
01
Patients who are unable to physically attend in-person medical appointments or lack access to local healthcare providers.
02
Patients with chronic illnesses or complex medical conditions that require ongoing monitoring and specialized care.
03
Patients who live in remote or underserved areas where access to healthcare services is limited.
04
Patients who prefer the convenience and flexibility of receiving medical care from the comfort of their own homes.
05
Patients who may have mobility limitations or transportation challenges that make it difficult for them to travel to healthcare facilities.
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What is clinical telehealth program referral?
A clinical telehealth program referral is a formal process by which a healthcare provider recommends a patient to receive services through telehealth, allowing access to medical consultations and treatments remotely.
Who is required to file clinical telehealth program referral?
Healthcare providers, such as physicians or specialists, who wish to refer patients for telehealth services are required to file a clinical telehealth program referral.
How to fill out clinical telehealth program referral?
To fill out a clinical telehealth program referral, providers must complete a referral form that typically includes patient information, the reason for referral, details about the requested telehealth services, and provider credentials.
What is the purpose of clinical telehealth program referral?
The purpose of a clinical telehealth program referral is to facilitate access to specialized healthcare services through remote technology, ensuring that patients receive timely and appropriate care.
What information must be reported on clinical telehealth program referral?
Information that must be reported includes patient demographics, medical history, purpose of referral, specific telehealth services requested, and the referring provider's information.
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