Submitting an Enrolment as a Referral

When Healthcare Providers opt into a Referral Workflow, they choose which enrolment forms are sent to their specified referral representative vs. sending straight to Program.

 

An enrolment form for Audit prem Program with a note indicating “based on your settings, currently this patient being enrolled will be referred to Placebo Referral”

Completing your enrolment form as a Referral is almost identical to completing a standard enrolment. How to Enrol a Patient in a PSP

When you open an enrolment form that is part of a Referral Workflow, you’ll notice a pink banner along the top of the form notifying you that this patient is being referred through the referral workflow.

After filling in the enrolment form and completing the Physician consent (and Patient consent, if applicable). Click the Complete Referral button.

Pencil icon NOTE The patient may need to consent TWICE when using the Capture Patient Consent button. Once for the Referral and again for the Patient Support Program.

The Enrolment Status reflects that the form is in Referral Review.

Erolment Status for Placebo drug that is currently in the state Referral Review.

The Referral Representative will review the enrolment form, verify patient consent is received, and click Submit once finalized to send the form to the program.

This is all reflected on the patient’s status tile, and in the Status Table in the Programs section.

Enrolment Status for Placebo drug that is currently in the state Submitted to Program.