For hospitals, physicians, facilities, and care teams

Refer a patient for primary care, wound care, or follow-through.

Use this path when a patient’s PCP sits outside the network, the discharge plan needs a clinical owner, or skilled home and facility needs exceed available local capacity.

Start the referral Call referral intake

Hospital referralsPhysician + APP referralsFacility referralsHome health + hospice

Send a referralthe Gateway care team

A practical referral workflow

Send the information that moves care forward.

1Your role, organization, and contact

2Patient setting, city, need, PCP status, and urgency

3The team confirms fit and the next secure step

Outside-network PCPsHome + facility capacityCommunication back

Send a referral

Send the practical details that help establish the right pathway.

Use initials only on this public form. Send records or detailed clinical documentation only through the secure channel provided after intake, or by fax when directed.

Leave blank

Referral source

Organization or practiceYour name and titleYour roleDirect phoneProfessional emailPreferred response

Patient and care setting

Patient initials onlyPatient city or ZIPCurrent care settingPrimary care, wound care, or coordination needPatient’s primary care relationshipRequested urgencyBest next contactBrief referral note No full records or attachments

Records and PHI: Use this form for minimum intake information only. Call 314-325-0126 or fax 314-786-7966 when instructed for the appropriate secure referral workflow. Do not paste full medical records, wound photographs, Social Security numbers, or detailed protected health information here.

I understand this public form is for referral coordination and that detailed records must move through the appropriate secure channel.

Referral line: 314-325-0126 · Fax: 314-786-7966