Clinician pathway
Clinician & Hospice Referral
A defined pathway for attending physicians, specialists, hospice teams, and palliative-care clinicians seeking independent review.
Referral standard
Send one complete referral package.
To support timely independent review, assemble the referral form, authorization, clinical summary, and supporting records before transmitting. Avoid partial packages or records sent through multiple channels.
Contact the practice for current delivery instructions before transmitting patient information.
Secure delivery instructions
Contact the practice for the current referral destination.
Complete package required
Submit the referral form, authorization, clinical summary, and supporting records together.
Complete package checklist
Include the information needed for review.
Referral & authorization
- Completed Baseline referral form
- Patient authorization for disclosure and contact
- Attending physician identity, contact information, and MAID participation status
- Patient contact information sent only through the secure channel
Clinical support
- Concise clinical summary and terminal diagnosis
- Current prognosis and its clinical basis
- Specialist, hospice, hospital, imaging, pathology, and laboratory records
- Medication list and relevant treatment history
- Required mental-health determination, when available or applicable
Workflow
What happens after secure receipt.
1 · Completeness check
Baseline checks whether the referral contains the materials needed for administrative and clinical review.
2 · Fit and acceptance
The request is reviewed for service fit and capacity. Transmission of a referral does not create a physician-patient relationship or guarantee acceptance.
3 · Secure coordination
If accepted, the secure patient portal supports questionnaires, consents, e-signatures, record uploads, scheduling, and clinical documentation.
Clinical boundaries
An independent consulting determination.
The consultant evaluates the statutory criteria and may request additional records, clarification, or an in-person examination. Confirmation may be declined.
The attending physician remains responsible for the formal request process and any prescribing decision. Payment and consultation do not guarantee eligibility.
Operational safeguards
- The live patient must be physically located in New York and may be asked to verify identity and location.
- Do not use this pathway for emergencies or urgent bedside management.
For an immediate threat to life or safety, call 911 or direct the patient to the nearest emergency department. For U.S. crisis support, call or text 988.