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Introduction
At the Boston Center for Oral Health (BCOH), we’re proud to partner with medical professionals in providing comprehensive care for patients experiencing sleep-related breathing disorders. Our team specializes in the evaluation and treatment of conditions such as obstructive sleep apnea, and we work collaboratively with referring physicians to ensure a smooth, evidence-based approach to care.
About the Form
The Online Medical Referral Form was designed to streamline the referral process for sleep disorder evaluations. It allows referring providers to securely submit essential patient information, including sleep study results, CPAP usage, insurance coverage, and clinical notes.
By submitting this form, you are taking the first step toward connecting your patient with effective, life-changing treatment options, including oral appliance therapy—an alternative to CPAP therapy for qualifying patients.
Form Sections Overview
- Patient Information
Full name, contact details, and date of birth. - Sleep Study Results
Including Apnea-Hypopnea Index (AHI) and test date. - CPAP Therapy Usage
Details about duration and current status. - Dental Provider Information
Contact details for collaborative follow-up. - Insurance Information
To verify coverage and expedite treatment planning. - Referring Provider Details
Ensures clear communication and continuity of care. - Additional Notes
Upload relevant documents or share observations.
Frequently Asked Questions (FAQ)
Dental Online Referral Form – Multi-Specialty Dental Practice
1. Who should use this referral form?
This form is intended for dental professionals, primary care providers, and specialists referring a patient to BCOH for advanced evaluation or treatment in any of our dental specialty areas.
2. What types of dental specialties can I refer a patient to?
You can refer patients for oral surgery, periodontics, endodontics, orthodontics, prosthodontics, pediatric dentistry, TMJ evaluations, implant consultations, or any other specialty care your patient may need.
3. Is this referral form secure and HIPAA-compliant?
Yes, the form is encrypted and HIPAA-compliant to protect sensitive patient health information throughout the referral process.
4. What information do I need to provide in the referral?
You’ll need to share patient contact details, reason for referral, diagnosis, tooth or area of concern, any imaging taken, clinical notes, and your contact information as the referring provider.
5. Can I upload X-rays and supporting documentation?
Absolutely. You may upload clinical documents such as X-rays, chart notes, treatment history, or referral letters in PDF, JPG, PNG, or DOC format.
6. How do I indicate urgency for the referral?
You can select from three urgency levels on the form: Routine, Soon, or Urgent, helping us triage and schedule your patient appropriately.
7. Do I need the patient’s consent to submit this form?
We recommend confirming that the patient has given permission to share their health information. A checkbox is provided to indicate consent for care coordination.
8. What happens after I submit the referral?
Our team will review the information, reach out to the patient to schedule an appointment, and communicate with you if we need additional details or updates.