New Patient Referral Form

Biomedical Health Partners will work together with your health care team, including home health, with the goal of healing your wound and improving your quality of life. We strive to streamline the referral and new patient process to get patients scheduled within a week.

​

While we accept most insurance plans, our primary patient has Medicare coverage. We do not require a medical referral but we do require the below information. 

1.  Completed New Patient Referral Form.

2.  Recent Progress Notes that include medical history,  wound care history and relevant lab results.

​

Referral Guidelines:

Indications to refer a patient: 

• Patients with non-healing wounds that have been present for more than 4-6 weeks.

• Patients with open wounds that measure 1cm or greater.    

• Patients with chronic wounds with nerve, tendon, bone or muscle exposed.

• Patients with non-healing venous stasis ulcers, diabetic foot ulcers, arterial ulcers, neuropathic ulcers, pressure injuries (previously called pressure ulcers), vasculitic ulcers, scleroderma ulcers and surgical or traumatic wounds.

How to refer a patient: 

1. Complete our New Patient Referral Form.  The online form will automatically download to our office via a HIPAA compliant format.  If you are unable to complete our online form, please contact our office and we will email or fax you a printable format.  

2. Provide the latest progress notes that include current medications and any relevant laboratory results. 

3. If you are unable to upload progress notes via our Secure Contact Form, please fax the documents.
   ​

Phone: 801.821.9047

Fax: 801.516.0639

​

 4. Once authorization is approved, your patient will be called to schedule a new appointment.  Authorizations typically take 48 hours.

​