Health Care Provider Network (HCPN)

Referral Guidelines
The Referral Guidelines

1. Pre-referral stage – this is the stage from the time the client/patient is
seen to the point where a referral decision is made.
a) The appropriate health provider (HP) evaluates the client’s
condition.
b) If needed, the HP orders laboratory tests to confirm assessment.
c) If a condition is beyond the HP’s expertise or the service needed is
not available in the health facility, the HP will determine the
category/subcategory (Annex A) of the condition and a referral
decision is made.
d) If the condition is not listed in the referral category list, this
condition is noted as unclassified in the referral form and is noted
for consideration in the next meeting of the referral committee.

2. Preparation for referral stage – From the time the referral decision is
made to completion of all the preparations and requirements for referral
are done
a) The HP explains the reason for referral to the client.
b) Fills up the referral form (Annex B) completely and has the
client/immediate family/ next of kin sign the consent statement.
c) Gives instructions to the client/patient or his/her relatives
concerning the referral slip, the name of the receiving facility, the
directions to the receiving facility’s location, name of specific area
to go to in the receiving facility, the name and designation of the
contact person or health provider to go to.
d) For non-emergency conditions:
i. The HP informs the client of the schedule or availability of
the service or specialist in the receiving facility.
ii. If required by the facility to make an appointment, makes
the call or instructs the client to call the receiving HP
iii. Instructs the client on any preparations needed before
going to the receiving facility
e) For emergency and urgent conditions:
i. Contacts and informs the primary receiving facility of the
incoming referral.
ii. Obtains the acceptance of the primary receiving facility.
iii. If unable to get acceptance from the primary receiving
facility for valid reasons, calls the secondary receiving
facility.
iv. If still unable to get acceptance from the secondary
receiving facility, calls the primary receiving facility for
assistance in resolving the referral.
v. Makes arrangements for transportation.
 vi. Provides all necessary stabilization measures to keep
patient’s vital signs within acceptable range during
transport.
vii. Packs medicines, IV fluids, and all thing necessary for the
safe transport of the patient.
viii. Informs the client of any charges or fees covering for the
materials and supplies used in the initial management or
transportation cost and have them settle this if patient
has the capacity to pay.
f) Fills the outgoing referral logbook (Annex C)
3. Transfer stage – From the time the preparations for referral are
completed to the arrival of the client/patient to the receiving facility.
a) For non-emergency and non-urgent conditions
i. The patient/client proceeds to the receiving facility
ii. Presents the referral slip to the receiving facility
b) For emergency and urgent conditions:
i. The HP accompanies the patient during transport
ii. Monitors vital signs while on travel and institutes
appropriate measures
iii. Continues recording management and medications given
including a record of the patient’s condition.
iv. Endorses the patient to the receiving facility
4. Receiving stage – From the time the referring facility informed the
receiving facility of the referral to the arrival by the patient and
acceptance of the referral and provision of initial treatment/management
a) For emergency and urgent conditions:
i. Upon receipt of the call of an incoming referral, the
contact person
 Informs the specialist of the incoming referral, the
patient’s diagnosis and condition and its
designated referral category
 Informs the admitting section of the incoming
referral and possible admission. The admitting
section subsequently looks for a free bed in the
designated ward.
 Informs the OR/DR complex of the arrival of the
incoming referral and possible emergency
procedure.
 Informs the blood center of the blood type of the
incoming referral.
 Informs the security unit of the incoming referral
and to facilitate the entry.
ii. Upon arrival of the referral
 The security unit facilitates the entry of the
referral to the ER.
  The security unit informs the contact person of
the arrival of the referral.
 The patient is immediately transferred to the ER.
 The ER staff receives the endorsement from the
referring HP.
 The ER staff makes an initial assessment and
makes the admitting orders.
 The ER staff fills up the return slip and returns this
to the referring HP.
 The ER staff attaches the referral slip to the
patient’s chart
 The ER staff fills the incoming referral logbook
(Annex D)
5. Post referral stage – From the completion of service to the discharge of
the client from the receiving facility
a) For non-admitted patients (diagnostic and consultation referral)
i. The receiving health provider gives the service and
advices the patient to return to the referring health
service provider
ii. Gives the diagnostic test results to the client (for
diagnostic referrals)
iii. Fills the return slip and instructs the client to give back to
the referring health provider
b) For admitted patients
i. The attending health provider orders the discharge of the
patient
ii. The Nurse on duty gives discharge instructions and
encourages the patient to continue follow up (if
appropriate) in the referring facility
c) The referring facility may inquire of the outcome of the referral

6. Monitoring and evaluation stage– The activities to determine the

functionality, performance, and areas for improvement of the referral
system
a) The Provincial Health Office organizes the provincial referral
committee (RC)
b) The HCPN coordinating committee can be designated as the RC if
desired by the province
c) The RC shall hold regular quarterly meetings to discuss:
i. Total number of referrals sent in the HCPN ( x = total
count of all outgoing referrals in the HCPN)
ii. Number and percent of referrals sent by facilities within
the HCPN (y = count of all outgoing referrals per facility,
percentage = y/x times 100)
 iii. Total number of referrals received in the HCPN (m = count
of all incoming referrals)
iv. Number and percent of referrals received by the facility (n
= Count of all incoming referrals received by facility,
percentage = n/m times 100)
v. Number and percent of unqualified referrals (p = count of
all inappropriate referrals (cases that do not need to be
referred or referred to the wrong facility), percentage =
p/x times 100
vi. Number and percent of unsuccessful referrals (q = count
referrals that were not received, percentage =q/x times
100)
vii. Unclassified referrals – conditions not listed in Annex A
viii. Referrals coming from other HCPN
ix. Number of referrals transferred to other facilities
(referrals accepted by receiving facilities but eventually
referred to another facility)
x. Number of Adolescent and Youth referrals (referrals
within the age range of 10 to 19 years old.
xi. Number of referrals for FP services ( BTL MLLA;
PPFP/PPIUD/ Interval IUD, others)
xii. Reasons for referrals
xiii. Reasons for transfer of referrals
xiv. Other concerns
xv. On an annual basis – updating of the referral guidelines
d) For the purpose of organizing the aggregated quarterly referral
report, all facilities in the HCPN shall submit the following data to
the PHO. These data is preferably sent in excel file for easier
handling by the PHO staff one week after the end of each quarter.
i. count of all outgoing referrals
ii. count of all incoming referrals
iii. count of all inappropriate referrals
iv. list of diagnosis of all inappropriate referrals within the
reporting period
v. count referrals that were not received by primary
receiving facility
vi. Unclassified referrals
vii. count of referrals from out of the HCPN
viii. count of referrals transferred to other facilities (for
receiving facilities only)
ix. count of Adolescent and Youth referrals (referrals within
the age range of 10 to 19 years old.
x. count of referrals for FP services ( BTL MLLA; PPFP/PPIUD/
Interval IUD, others)
 xi. Reasons for referrals (if for transfer service and
consultation, please indicate the referring impression)
xii. Reasons for transfer of referral
e) Report quarterly to the DOH regional office on the outcomes and
decisions of the referral committee meetings