Referral Consultation

1. A regulated member must recognize his or her limitations in the delivery of patient care and collaborate as appropriate with other healthcare providers for the benefit of the patient.
2. A regulated member must respect a patient’s reasonable request for referral to another healthcare provider for:
   1. a second opinion about the medical care provided; or
   2. services outside the scope of practice of the regulated member.
3. Notwithstanding clause 2, a regulated member is entitled to refuse to make a referral that, in his or her opinion, is unlikely to provide a clinical benefit.
4. When a regulated member believes that consultation by another healthcare provider is appropriate but the patient does not, the regulated member must:
   1. discuss with the patient and document in the patient’s record the difference of opinion and the implications of care; and
   2. continue to provide medical care that is in the best interest of the patient and within the scope of the regulated member’s practice.
5. A regulated member who refers or accepts a patient for consultation must inform the patient of the regulated member’s role and responsibilities in the patient’s care.
6. A regulated member who refers a patient for consultation must:
   1. discuss the purpose of the referral with the patient and confirm the patient’s agreement;
   2. inform the patient about any fees that may not be covered by the Alberta Health Care Insurance Plan if aware such fees are likely to be charged;
   3. evaluate and workup the patient within the regulated member’s scope of practice, including performing appropriate investigations; and
   4. make a timely, written request for consultation that includes the following information:
      1. patient’s name, Personal Health Number and contact information;
      2. regulated member’s name and contact information;
      3. name and contact information of the consultant or consulting service;
      4. date of referral;
      5. purpose of the referral, including but not limited to specifying if the referral is solely for the purpose of a third-party request;
      6. pertinent clinical information, including but not limited to the relevant investigation results; and
      7. expected consultation outcomes (e.g., medical opinion only, possible transfer of care, other).
7. A regulated member who refers a patient for an urgent and/or emergency consultation must:
   1. contact the consultant or emergency service directly to discuss the referral and provide pertinent clinical information; and
   2. to the extent possible, provide relevant documentation.
8. Notwithstanding clause 6(d), a regulated member may forego a written request for consultation in an urgent and/or emergent situation if the consultant or service agrees to accept care of the patient without a written request.
9. A regulated member who provides consultations must¹:
   1. make information available to referring healthcare providers about the process for receiving requests for consultation and ensure:
      1. receipt of request is acknowledged to the referring healthcare provider within seven (7) days; and
      2. the decision to accept or deny a request is communicated to the referring healthcare provider within a time commensurate with the urgency of the request, but no longer than fourteen (14) days after the request was received;
   2. be reasonably available to respond to requests for consultation; and
   3. if denying a request for consultation, provide reasons and, whenever possible, alternative suggestions for care or consultation.
10. A regulated member who accepts a request for consultation must:
    1. contact the patient within a time commensurate with the urgency of the request, but not longer than fourteen (14) days after the request was received; and
       1. schedule an appointment date or, if an appointment date has not been determined, confirm the referral status with the patient and the referring healthcare provider at least every three (3) months;
       2. inform the patient of any fees not covered by the Alberta Health Care Insurance Plan;
    2. provide a written report directly to the referring healthcare provider no more than thirty (30) days after initially seeing the patient, that includes the following information:
       1. the identity of the consultant;
       2. the identity of the patient;
       3. the identity of the referring healthcare provider and, if known, the identity of the patient’s primary care physician;
       4. the date of the consultation;
       5. the purpose of the referral as understood by the consultant;
       6. information considered, including history, physical findings and investigations;
       7. diagnostic conclusions;
       8. treatments initiated, including medications prescribed;
       9. recommendations for follow-up by the referring healthcare provider;
       10. recommendations for continuing care by the consultant;
       11. recommendations for referral to other consultants; and
       12. advice given to the patient;
    3. inform the referring healthcare provider when a consultation will extend beyond one appointment and provide interim reports to the referring healthcare provider as required; and
    4. notify the patient and referring healthcare provider when the consultation is complete and patient care is being transferred back to the referring healthcare provider or transferred to another healthcare provider.
11. Notwithstanding clauses 6(d) and 10(b), a regulated member must respect a patient’s explicit request to withhold pertinent medical information and inform the consulting/referring healthcare provider when information has been withheld.
12. A regulated member who refers a patient for a non-urgent consultation must not send the same consultation request to multiple providers concurrently.
13. A regulated member must not:
    1. require a repeat referral for a patient with whom the regulated member already has an established physician-patient relationship² for the purpose of gaining an additional consultation fee; or
    2. require a referral from a healthcare provider if the regulated member has arranged to see a patient without a referral.

^{1. The College will review complaints about management of consultation requests brought by other healthcare providers and patients.}

^{2. In an established physician-patient relationship, both the regulated member and patient have a reasonable expectation the care provided will extend beyond a single encounter. Established physician-patient relationships include but are not limited to:
a. longitudinal relationships, based on the identification of a regular attending physician or clinic; and
b. sessional relationships for a defined period of time, based on a presenting concern(s), referred consultation or identified medical condition.}