St. Louis Partners Form

Under Requesting Agency - What ever is checked off will be the program name 

1. Patient Name

2. DOB

3. DCN is REQUIRED - Put in Patient ID 2 (If not listed, DO NOT UPLOAD.  Email customer and let them know we need DCN to upload referral)

4. Case Manager Name - Put in Case Manager 1

5. If Frequency is selected, Change Frequency group.  If not selected, leave as manual

6. Save at bottom

Under Testing Tab

1. Under Custom Panel select the panel listed under Step 3 on Referral.  End date for panel can be None and Click Save at bottom

2. Under Notification Settings, IF they said yes to enroll patient in SMS Text Notifcations,

   a. Change Text Notification from No to Yes and enter phone number and click save at bottom

3. On referral, check to see what Office is checked off.  If it does not match the Collection location, update to match

4. Save

Go back to Summary Information Page and click the paper clip. Upload referral and save

Email Customer to state the referral has been uploaded