Referrals

A referral can be sent successfully and still go nowhere. The receiving clinic may need another document, the patient may need help scheduling, or the consultation note may never make it back to the referring team. A useful referral workflow keeps those next steps visible.

In Medplum, start with a ServiceRequest for the requested clinical service. Add Tasks for the work around it and link the messages, documents, appointments, and results as they arrive.

Plan the workflow first

Use the Referrals Decision Guide to decide which sending, receiving, and follow-up steps your product supports. You can build either side of the exchange without implementing every workflow in this section.

Decide Whether the Teams Share a Project

For an internal referral, such as primary care referring to the practice's behavioral health team, both teams can use the same ServiceRequest. Create the receiving team's Task directly, assign its owner, and track acceptance and follow-up. Use Communications when the teams need to exchange context; a separate delivery workflow is optional. Configure access for each team's work and clinical records.

For a referral to another system, add the transmission and intake steps: agree on identifiers and supported payloads, track delivery, resolve incoming patient references, and reconcile status updates. Each server uses its own local resource IDs while preserving the business referral identifier.

The worked example uses two teams in one project so every reference can be followed locally. The same milestones apply across systems, with the integration carrying messages and status updates between them.

Connect the Request to the Work Around It

Resource	Role in the workflow
ServiceRequest	The requested service, patient, requester, intended performer, and clinical context
Task	An accountable work item, such as intake review, scheduling, or reviewing the returned note
QuestionnaireResponse	Answers captured in a referral form, retained alongside the resulting request
Communication	Messages about the referral, including the material sent and relevant transmission times
DocumentReference and Binary	Document metadata and the actual file bytes
Appointment and Encounter	The booking and the care interaction that follows
DiagnosticReport or another clinical result	Evidence of the service provided

You can follow these links from the clinical request to the work, messages, and evidence around it. Each patient-related resource also needs its own patient reference. The arrows in this diagram connect clinical and workflow context; access is enforced by AccessPolicy and ProjectMembership.

Know What Each Milestone Actually Tells You

A delivery receipt tells you that a package arrived. It does not tell you that the clinic accepted the referral or that the patient received the service. Track these milestones separately:

Milestone	Evidence
Package delivered	Channel acknowledgment correlated to the outbound message
Referral accepted	Receiving team's explicit acceptance of the work
Visit scheduled	Appointment linked to the ServiceRequest
Service performed	Encounter or clinical result, with request status reconciled by the responsible party
Loop closed	Returned information reviewed and any required follow-up assigned

ServiceRequest.status describes the clinical request. Task.status describes a particular unit of work. Use Task.businessStatus for local stages such as waiting for documents; keep the meaning of each stage consistent across the UI and automation.

Build Your Referral Workflow

1. Creating and Capturing Referrals: forms, draft orders, identifiers, and release.
2. Recipients and Referral Packages: directory choices, supporting context, and file handling.
3. Sending Referrals and Tracking Delivery: channels, communication records, acknowledgments, and retries.
4. Receiving and Triaging Referrals: source retention, patient matching, duplicate handling, and review.
5. Processing and Coordinating Referrals: ownership, authorization, scheduling, and rerouting.
6. Results and Closing the Loop: matching returned records and defining completion.
7. Worked Referral Example: a connected set of R4 resources.

For patterns shared with other practice workflows, see Care Coordination, especially Tasks and Work Queues and Handoffs and Escalation.