7.4 Referrals and Follow-up

Part II: Guidelines for Client Services and Clinic Management


Delegate agencies must provide all services listed in Section 8.0 under "Required Services" either on-site or by referral (unless specified as required on site by IDHS). For required services provided by referral, the project must have in place formal arrangements regarding the provision of services and reimbursement of cost with the referral organization, as appropriate.

For services determined as necessary, but which are beyond the scope of the family planning project, the client must be referred to other providers for care. When a client is referred for non-family planning or emergency clinical care, agencies must:

  • Make arrangements for the provision of pertinent client information to the referral provider. Agencies must obtain the client's consent to such arrangements, except as may be necessary to provide services to the client or as required by law, with appropriate safeguards for confidentiality;
  • Advise the client on their responsibility in complying with the referral; and
  • Counsel the client on the importance of such referral and the agreed upon method of follow-up.

Agencies should provide for the coordination and use of referral arrangements with other providers including health care providers, local health and human services departments, hospitals, voluntary agencies and health service projects supported by other Federal and State agencies.

  • Referral providers must be selected by procedures that assure fairness in the selection process and that identify providers of high quality.
  • Referral provider lists must be updated annually.

Delegates must have written protocols and operating procedures for referrals and follow-up. These written procedures must include referrals and follow-up that is needed as a result of abnormal physical examination or laboratory test findings. These procedures must be sensitive to clients' concerns for confidentiality and privacy.

Delegate agencies referral procedures must include a description of the arrangements for:

  • Emergency referrals, which require immediate referral to the provider;
  • Urgent referrals, which should be followed-up with the client in a brief, specified period (e.g. 2 weeks);
  • Essential referrals, which are followed-up with the clients within a timeframe determined by the clinician;
  • Discretionary referrals, which are followed-up with the client as necessary;
  • Client consent for the release of pertinent information to another provider;
  • The appropriate documentation that the referral was made and the follow-up has taken place, as needed; and
  • The system for obtaining feedback from the client about referral providers.

Additionally, follow-up system should include procedures that document:

  • A method to identify clients in need of follow-up;
  • The action taken to follow-up on referred clients (e.g., confirming that the referral appointment was kept);
  • The client information was received from the referral provider and placed in the medical record;
  • The action taken to implement the recommendations from the referral provider or the reasons why the recommendations were not implemented;
  • The client has been given a complete explanation of the referral and the need for follow-up including:
    • The reason for the referral;
    • The services to be received from the referral provider;
    • Directions to the referral agency;
    • When to return to the family planning clinic;
    • Any instructions needed to help insure the client will follow through with the referral and follow-up; and
    • An assurance of confidentiality.

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