Contact person: Business Client

Phone:Show

Email:Show

Location: Brampton, Canada

Budget: Recommended by industry experts

Time to start: As soon as possible

Project description:
"I need to create a referral document that can be shared by medical doctor and rehab clinic where the doctor can sign off on specific products based on some medical findings by the rehab clinic. Once the rehab clinic fills in the diagnosis the form is sent to the doctor for product recommendations and signature and date then it is sent back to rehab clinic to be processed and approved by the insurance company. both doctor and rehab clinic should have a copy of the referral. We also need to track doctor payment for referral. Once product(s) are selected a list of products with claimant name and date needs to be emailed to medical supply company for processing. This form should be a fillable Pdf with a submit button that triggers all these things. I have attached an image of the current referral pad that needs to be put into a fillable pdf format.

The rehab clinic fills out patient and diagnosis info.

The form is emailed to the doctor for completion and e-signature.

Once signed, it’s returned to the clinic.

The clinic then triggers an automatic email to the medical supply company (with claimant name, products, and date).

Optionally logs the doctor referral payment for reporting." (client-provided description)