Provider Manual · Part XIII

Referrals & external care

Care beyond your walls: order referrals and imaging, send the letters, track what's outstanding, and capture the consult reports that come back.

6 sections~12 min read3 screenshots
XIII
Part XIII

Referrals & external care

Care beyond your walls: order referrals and imaging, send the letters, track what's outstanding, and capture the consult reports that come back.

13.1Ordering referrals

Order a referral to a specialist

A referral is an order type, placed from the same Orders search you use for prescriptions and labs (see Order medications, labs, imaging & more). You look the receiving provider up in the national NPPES registry, describe why you’re sending the patient, and Hero EMR generates and faxes the referral letter when you sign the order.

  1. Find New Referral. In the encounter’s Orders section, type ref into the order search (F7 or Ctrl+O jumps straight to it), or open the Search Orders window and switch to the Referral tab. Pick the result New Referral — “Refer patient to specialist”.
  2. Search for the receiving provider. The Search for Provider panel queries the national NPPES registry — not your practice’s own provider directory. Fill in at least one of First Name, Last Name, Specialty, City, or State, then click Search Providers (Enter works too). Each result shows the provider’s credential, specialty, city and NPI, plus a fax number when NPPES has one on file. Click a result to select it — a green summary shows their contact details, and Change Provider reopens the search.
  3. Describe the referral. Enter the Reason for Referral (required — for example “Evaluation of chest pain and abnormal EKG”), set the Urgency (Routine, Urgent, or STAT), and add Clinical Notes with the history and exam findings the specialist should see.
  4. Choose Fax Delivery. The Delivery Method panel offers two cards: Electronic Delivery (tagged Recommended) and Fax Delivery. Choose Fax Delivery — direct electronic delivery to outside EHRs is still on the roadmap, and today the letter travels by fax in every case, so a provider without a fax number cannot receive it. If NPPES had no fax on file, an Enter Fax Number Manually field appears (“No fax number found in NPPES registry”) — get the number from the specialist’s office and type it in.
  5. Click Add Referral. Hero validates first — a selected provider with an NPI and a reason are both required — then the referral lands on the encounter’s order list with a Ref badge, the provider’s name and specialty, and a Reason: line.
Search Orders window with type filter tabs including All, Medication, Lab, Imaging, Referral, Screeners and Forms, showing a controlled-substance medication result
The Search Orders window’s type tabs include Referral — or just type ref to surface New Referral.
Referrals are encounter-only. The standalone Create Orders window handles medications, labs, and imaging outside a visit, but it cannot submit referral orders — always place referrals from inside an encounter.
No pencil on a placed referral. A referral card offers Remove referral (trash), Save as favorite (star — it reappears under the Favorites tab of Search Orders; see Favorites), and Sign & Send. To change any detail, remove the referral and add it again.
13.2Referral letters

Sign & send the referral letter

There is no separate letter to compose. When you send a referral, Hero EMR generates the PATIENT REFERRAL FORM — a PDF carrying your referring-physician block and saved signature, the patient’s information, the receiving provider, the reason, clinical notes and urgency, and the visit’s diagnosis codes — and faxes it from your practice’s fax line. That PDF is the referral letter.

  1. Link a diagnosis first. The referral row’s Sign & Send button stays disabled until the encounter has at least one diagnosis and that diagnosis is tied to the referral in the Associations grid. The tooltip tells you what’s missing — Cannot send: Add a diagnosis to the encounter, or Associate a diagnosis with this referral.
  2. Click Sign & Send. Hero assembles the letter (STAT and Urgent referrals carry a warning banner on the form) and faxes it via your practice’s SRFax line with a cover page reading Referral for <patient name>. While a send is in flight, other users see a lock badge (“<name> sending…”); if a lock looks stuck, Hero offers to override and send anyway.
  3. Confirm the green Sent badge. A successful send turns the row’s badge to Sent with a Referral ID: reference — check that you actually see it before moving on (see the failure note below if you don’t). A sent referral is immutable; reprint or re-download the letter any time from the Referrals inbox with its PDF button.
If the send fails: a Failed to send referral toast means the letter was not confirmed sent — depending on where the send failed, the referral either stays unsent or appears in the Referrals inbox with a failed badge. Retry from the same row; if the error appeared late in the send, confirm with the receiving office (or your fax provider’s outbox) before retrying so the letter isn’t delivered twice.
Prerequisites: placing and sending referrals requires the physician or admin role (staff see “Order placement requires physician privileges”), and the PDF embeds the saved signature from your physician profile — add one before your first referral. During a downtime window the button is disabled with Referrals are unavailable during downtime.
13.3Imaging orders

Order an imaging study

Imaging goes through the same Orders search, but the catalog behind it is your practice’s own: studies come from the radiology providers configured under External providers, with contrast variants of the same study consolidated into a single result.

  1. Find the study. Search by name (for example mri) or use the Imaging tab of the Search Orders window. If the search instead reports “Imaging provider visibility is misconfigured. Ask an admin to select at least one send-ready provider or switch mode to all.”, an admin needs to adjust the imaging-provider visibility setting first.
  2. Describe the study. The dialog opens titled with the composed study name (for example MRI Brain With Contrast). Enter the required Clinical Indication (“Reason for imaging study…”), then set Contrast (Without Contrast, With Contrast, or With and Without Contrast — only the variants the chosen provider actually offers), Laterality (Left / Right / Bilateral, required only for sided studies), the Provider, the Urgency, and any Special Instructions.
  3. Confirm the patient weight. Patient Weight (lbs) auto-fills from the latest chart vitals. It’s mandatory for RadNet-routed orders — the helper text reads Required for RadNet submission if no recent weight is available in vitals. — and must be a whole number between 1 and 999.
  4. Answer the Contrast Safety Questionnaire. Choosing any contrast option reveals safety checkboxes, including Patient has known allergy to IV contrast (which warns “Warning: Consider alternative imaging or consult with radiology.”) and a diabetes question. Then click Save Changes to add the order.
  5. Sign & send — and cancel if plans change. The order appears with an Img badge and sends like a referral: link a diagnosis (“Associate a diagnosis with this imaging order”), then Sign & Send. If contrast or laterality is still missing, Imaging order needs an update reopens the dialog. On success the row shows Sent and Order ID:, and gains a Cancel button that opens the Cancel Imaging Order dialog (“Are you sure you want to cancel this imaging order?”) with reasons Duplicate Order, Ordered by Mistake, and Testing Not Needed. Cancellations of RadNet orders are forwarded to the imaging center.
Create Orders modal with a Select pharmacy field, a unified search box for medications, labs, imaging, screeners and forms, an empty cart reading No orders added, and a Send 0 Orders button
Unlike referrals, imaging can also be ordered outside a visit from the standalone Create Orders window.
No encounter open? No problem. Imaging orders can be placed from the standalone Create Orders window (F7 or Ctrl+O); when you click Send N Orders, Hero shows “Creating encounter and sending orders…” and files a lightweight encounter for you automatically.
Contrast follows the provider. The Contrast choices are limited to what the selected provider’s catalog offers, so switching Provider can change which options exist — recheck after a switch. During a downtime window imaging is blocked: Imaging is unavailable during downtime.
13.4RadNet Connect

How RadNet Connect orders flow

If your practice has RadNet Connect configured (an admin sets it up under External providers), imaging orders routed to a RadNet provider transmit electronically in the background the moment you Sign & Send — no fax to dial, no phone call to make.

  1. Hero matches the patient. The patient’s demographics and primary insurance are mapped to RadNet’s format, and Hero finds — or creates — the matching patient on RadNet’s side. Orders missing required demographics fail with a specific reason, so keep the chart complete.
  2. The order is submitted. The exam from your procedure catalog is sent with the order details, and RadNet’s confirmation reference is stored on the order for later lookup.
  3. Failures come back to you. If transmission ultimately fails, the ordering provider receives an entry in the Results inbox titled RadNet order failed: followed by the study — including the failure reason, modality, body part, and reason for study. Failures are never silent.
Order statusWhat it means
pendingCreated in Hero, not yet transmitted.
submittedAccepted by RadNet; the confirmation reference is on file.
scheduledThe imaging center has booked the patient.
imagedThe study has been performed.
completedThe study is finalized.
failed / canceledTransmission failed, or the order was canceled — cancellations placed in Hero are forwarded to RadNet. Statuses only ever move forward.
Set expectations on what comes back. Scheduling and completion updates are pulled from RadNet on demand and may not advance automatically on screen — confirm the appointment with the patient or the center. The report itself arrives on your fax line and is imported by hand (see Incoming reports), not as an automatic download.
Not connected? Orders to a provider without an electronic route (RadNet or RAYUS) are not transmitted automatically — keep your manual workflow of printing or faxing the requisition for those centers.
13.5Referral tracking

Track sent referrals in the Inbox

Every referral you send is tracked in the Referrals view of the Inbox — the Referrals item (send icon) in the left sidebar, with an unread-count badge. It lists every non-draft referral for the practice, newest first, each entry titled Referral to <provider name>.

  1. Open a referral. The header shows Referral with a status badge, the subject, a Patient: line, a Referred to: line with the provider’s name and specialty, and Fax: with the number on file.
  2. Read the detail. The body shows a Reason section with the referral reason and a Timeline with Created and Updated timestamps.
  3. Reprint the letter. The PDF button (it reads Preparing… while generating) regenerates the PATIENT REFERRAL FORM and opens it in a new tab — this is how you re-download or reprint a referral letter after the fact.
  4. Triage like any inbox item. Mark referrals read or unread and flag the ones you’re chasing — flags and read state are shared across the organization.
Status badgeMeaning & what to do
sentThe letter was generated and queued to your fax line. Confirm receipt with the receiving office by phone or fax.
failedThe send didn’t complete. Retry from the referral row in the encounter (see Referral letters).
draftCreated but never sent — drafts do not appear in this view at all.
Tracking is not closed-loop. There is no delivery-confirmation sync from the fax service back to the referral, and nothing in the workflow marks a referral acknowledged or scheduled — a healthy referral simply reads sent indefinitely. Confirm receipt and the patient’s specialist appointment directly with the receiving office.
Staff access is permission-gated. Staff can be granted the referral permissions in the staff permission catalog — referral.view (view referral records), referral.manage (create, edit, send, and track referrals), and referral.coordinate (coordinate incoming referrals, PDFs, and routing) — but actually sending orders and referrals remains physician/admin-only regardless.
13.6Incoming reports

Receive consult reports & review the Letters tab

What comes back from outside care lands in three places: incoming documents arrive in the Faxes inbox, returned imaging surfaces on the chart’s Imaging tab, and the chart’s Letters tab keeps the history of every letter generated for the patient.

  1. Import incoming faxes. Consult notes and imaging reports from outside providers usually arrive on your fax line. In Faxes, use Link patient & import (the button reads Linking & importing… while it works) to attach the document to the right chart — full mechanics in Import faxes into the chart. Imported documents are auto-classified — consultation notes file as clinical notes, referral paperwork as Referral — and land on the chart’s Media tab.
  2. Review returned imaging. Reports attached to an imaging order surface on the chart’s Imaging tab with status chips Pending, No findings available, Normal study, and Abnormal. Opening a study shows the Technique, Findings, and Impression parsed from the report, the Accession Number:, and an Add to Note button to pull results into your documentation — report review in depth lives in Imaging results.
  3. Check the Letters tab. It lists every generated letter and form with columns Date Requested, Physician, Type of Letter, Approval Status, and a View action, sortable by Date, Physician, Type, or Status. Status chips run Pending Review, Approved, Rejected, Completed, Processing, and Failed; letter types include Referral, FMLA Letter, Work/School Note, Insurance Letter, and Medical Summary.
  4. Spot records the patient imported. Records a patient pulls in from Epic-based health systems through the portal’s record-import flow appear in the chart with an Imported from Epic badge on imaging studies and medications — handy when reconciling outside care.
Chart Letters tab listing seven letters including a WA Paid Leave Form, FMLA Letter, and Work Excuse Letter, each with an Approval Status badge of Pending Review or Approved and a View action
The Letters tab is the patient’s letter history — every generated letter with its approval status and a View action.
Imaging reports don’t return automatically. RadNet does not push the report back into Hero — it arrives by fax and must be linked & imported, and the Imaging tab’s status stays Pending until a report is attached to the order.
The Letters tab is read-only history. There’s no compose button here: most of these letters originate as patient requests from the portal and are approved in the Inbox’s Forms/Letters view (approval requires your saved signature), while the day-to-day referral letter is the auto-generated PATIENT REFERRAL FORM from Referral letters.

Need help? Email support@heroemr.com.