Digital referral

When referring a patient to a medical specialist, the referral must always be formalized, at least for all specialties where it is required by law. A referral is required both when referring a patient from a family physician to a medical specialist and from one medical specialist to another one.

The referral is issued to the patient only for a medical indication. The referral must clearly state the medical issue or hypothesis that justifies the need to refer the patient to a medical specialist. Only relevant and underpinning information from the medical history shall be added to the referral.

• If necessary, the family physician can also use the e-consultation service. In this case, the family physician sends the issue related to the patient's treatment directly to the medical specialist through the health information system. The issue will be reviewed by the medical specialist, and the family physician will be consulted on the patient's further treatment, or the patient will be invited to the medical specialist’s appointment, i.e. the patient will be taken over by the medical specialist. The family physician always informs the patient when he/she asks the medical specialist for an e-consultation and also asks for the patient's contact telephone number, which is indicated in the referral letter.
• The medical specialist will provide feedback to the family physician through the health information system within four working days at the latest. If the medical specialist decides to invite the patient, the latter will be contacted within six working days, taking into account the urgency of their health problem, so it is important that the patient's telephone number is correct and that the patient him/herself is available by telephone during this period.

• The digital referral is sent to the health information system. Paper referrals will no longer be issued.
• The referral will not be issued retroactively to the patient. For example, in a situation where an appointment with a medical specialist is already underway or has taken place, it is no longer possible for the family physician to issue a digital referral for that appointment. 
• The digital referral has an expiration time. This is the time during which it is possible to book an appointment with the referral. The appointment may also take place later, after the expiration of the referral, i.e. if the patient has booked an appointment on the basis of a valid digital referral, the referral no longer needs to be valid on the day of the doctor's appointment.  The expiration time in the family physicians’ programs is six months by default, but the issuer of the referral can change this period if necessary. 
• You can only book one time at once with a digital referral. When booking an appointment, it is checked whether a digital referral is available, and whether it is already associated with an appointment.
• The patient can book a new appointment on the basis of the same referral, if the current appointment has been cancelled. From the patient portal, both issued and booking-related referrals are visible to the patient.
• Even if the patient does not show up for the appointment or the doctor / service provider cancels the appointment, the referral will be released from the old booking and the patient can use it to book a new appointment if the referral has not expired.

• The digital referral is sent to the health information system. Paper referrals will no longer be issued.
• The referral will not be issued retroactively to the patient. For example, in a situation where an appointment with a medical specialist is already underway or has taken place, it is no longer possible for the family physician to issue a digital referral for that appointment. 
• The digital referral has an expiration time. This is the time during which it is possible to book an appointment with the referral. The appointment may also take place later, after the expiration of the referral, i.e. if the patient has booked an appointment on the basis of a valid digital referral, the referral no longer needs to be valid on the day of the doctor's appointment.  The expiration time in the family physicians’ programs is six months by default, but the issuer of the referral can change this period if necessary. 
• You can only book one time at once with a digital referral. When booking an appointment, it is checked whether a digital referral is available, and whether it is already associated with an appointment.
• The patient can book a new appointment on the basis of the same referral, if the current appointment has been cancelled. From the patient portal, both issued and booking-related referrals are visible to the patient.
• Even if the patient does not show up for the appointment or the doctor / service provider cancels the appointment, the referral will be released from the old booking and the patient can use it to book a new appointment if the referral has not expired.

• If the medical specialist finds that the patient needs to attend another specialist’s appointment, a new referral will be made by the same specialist. The patient does not have to go back to their family physician to receive a referral.
• If the medical specialist places the patient in his/her observation and the appointment schedule is open until that time when he/she calls the patient again, the medical specialist shall book a new time for the patient and shall not have to formalize a referral. In case that the patient needs to change the appointment time, he/ she will be given a contact number / e-mail address, etc.
• If the medical specialist places the patient in his/her observation and the appointment schedule is not yet open until that time when he/she calls the patient again, the medical specialist shall formalize the patient’s referral in the usual outpatient referral form (so-called recurring referral). In this case, the patient does not have to address the family physician again for a referral, but can be sure that a new appointment time can be booked with a referral issued by the medical specialist. If, for technical reasons, the hospital is unable to formalize a recurring referral, the patient will be given a written reminder which can be used as a basis for booking a new appointment time.
• At the end of treatment, the medical specialist must always state in the treatment summary (or epicrisis) whether to leave the patient to be monitored or refers the latter to the family physician. The family physician can use this information if necessary through the health information system.