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I. Type of Medical Service Request II. Identification of Patient Type to Refer III. To Make a Patient Referal

I. TYPE of MEDICAL SERVICE REQUEST

A. Interdisciplinary Medical Team Evaluation and Conference for Treatment Recommendations.

B. Programs

1. Functional Restoration Program
2. Chronic Pain Management
3. Early Intervention Program
4. Pre and/or Post Surgical Intervention

C. Specialized

1. Case Management Service
2. Behavioral Medicine and Psychological Services
3. Pharmacy Evaluation and Counsulting Service and Detoxification Management
4. Physical Therapy and Occupational Therapy Services
   
   • Work Hardening
   • General Therapy
   • Hand Therapy
5. Nutrition Evaluation and Counseling
6. Acupuncture Treatment
7. Vocational Rehabilitation Counseling

II. IDENTIFICATION of PATIENT TYPE to REFER

A. Acute Patient:

1. Early intervention for medical management of high-risk patients
2. Surgical Intervention
   • Orthopedic Pre-Op
   • Orthopedic Post-Op
3. Patients who fail to progress within the guidelines
   of standards of practice
4. Patients requiring medication management
5. Case disposition - medical discharge, return to work

B. Sub-Acute Patient

1. Patient with symptoms of both acute and chronic pain needing to become more functional.
2. Case disposition - medical discharge, return to work

C. Chronic Patient

1. Patients with psychosocial issues complicating course of recovery
2. Patient showing little motivation or advancement to discharge and return to work
3. Medication management and/or detoxification
4. Case disposition - medical discharge, return to work

D. Special

1. Patients who require a controlled care environment
   and focused medical team
2. Patients who geographically have difficulty accessing care

III. TO MAKE A PATIENT REFERRAL

A. Referring physician dictates referral and type of medical service request.

1. The dictation should indicate if the referring physician has completed care.

B. Submit request for authorization for Intergrated Healthcare Resourses (IHR) Medical Team evaluation and conference for RX recommendation.

1. FAX copy of authorization request and dictation to: Integrated Healthcare Resources. (775) 828-5533.

C. Assistance to obtain authorization is available.

1. Integrated Healthcare Resources Case Manager
2. Integrated Healthcare Resources Business Coordinator
3. Don't hesitate to seek our help.
   eMail IHR Office or Call (775) 828-5522

D. Referral Approval

1. Notify Integrated Healthcare Resources - We'll take it from there.
   • Notify Patient
   • Obtain records and any films

E. Ongoing Communication and Reporting from Integrated Healthcare Resources

1. Reports will be sent to Referring Physician
2. Patient's final disposition

Contact IHR for discussion of or copies of Patient Outcome Data and Patient Satisfaction Services. Call 775 828-5522 or eMail Office