DOCUPIPE

Solutions

Resources

Pricing

Make sense of any

Referral Form

Generate accurate and consistent data from any document, any layout.

Healthcare Document Intelligence

The world's best referral form extraction

Accelerate specialist referral workflows with automated form processing. Extract referring and receiving provider details, patient demographics, clinical indications, and urgency levels. Reduce referral leakage and improve care coordination.

referral-form.pdf

Viewer

JSON

referral_date

2024-03-18

referral_number

REF-2024-45678

urgency

Routine

patient_name

Emily R. Johnson

patient_dob

1989-07-12

patient_phone

(555) 867-5309

patient_address

456 Maple Drive, Seattle, WA 98101

patient_insurance

Aetna PPO

insurance_member_id

AET789456123

referring_provider_name

Dr. Michael Torres, MD

referring_provider_npi

1234567890

referring_practice

Seattle Family Medicine

referring_phone

(555) 234-5678

referring_fax

(555) 234-5679

specialist_type

Cardiology

referred_to_provider

Dr. Lisa Wang, MD

referred_to_npi

0987654321

referred_to_practice

Pacific Heart Specialists

referred_to_phone

(555) 345-6789

referred_to_fax

(555) 345-6790

primary_diagnosis

Palpitations

primary_diagnosis_icd10

R00.2

Secondary_diagnoses

1 item

diagnosis

icd10_code

Anxiety disorder

F41.9

reason_for_referral

Patient experiencing frequent palpitations, episodes lasting 5-10 minutes, occurring 2-3 times weekly for past 2 months. ECG showed occasional PVCs. Requesting cardiac evaluation and possible Holter monitoring.

relevant_history

No prior cardiac history. Family history positive for atrial fibrillation (mother). Non-smoker. Moderate caffeine intake.

Current_medications

1 item

medication

dosage

Sertraline

50mg daily

Tests_performed

3 items

test

date

result

12-lead ECG

2024-03-15

Occasional PVCs, otherwise normal

CBC

2024-03-15

Within normal limits

TSH

2024-03-15

2.1 mIU/L (normal)

services_requested

Cardiac evaluation, Holter monitor, Echocardiogram if indicated

authorization_status

Pending

authorization_number

null

{ "referral_date": "2024-03-18", "referral_number": "REF-2024-45678", "urgency": "Routine", "patient_name": "Emily R. Johnson", "patient_dob": "1989-07-12", "patient_phone": "(555) 867-5309", "patient_address": "456 Maple Drive, Seattle, WA 98101", "patient_insurance": "Aetna PPO", "insurance_member_id": "AET789456123", "referring_provider_name": "Dr. Michael Torres, MD", "referring_provider_npi": "1234567890", "referring_practice": "Seattle Family Medicine", "referring_phone": "(555) 234-5678", "referring_fax": "(555) 234-5679", "specialist_type": "Cardiology", "referred_to_provider": "Dr. Lisa Wang, MD", "referred_to_npi": "0987654321", "referred_to_practice": "Pacific Heart Specialists", "referred_to_phone": "(555) 345-6789", "referred_to_fax": "(555) 345-6790", "primary_diagnosis": "Palpitations", "primary_diagnosis_icd10": "R00.2", "secondary_diagnoses": [ { "diagnosis": "Anxiety disorder", "icd10_code": "F41.9"} ], "reason_for_referral": "Patient experiencing frequent palpitations, episodes lasting 5-10 minutes, occurring 2-3 times weekly for past 2 months. ECG showed occasional PVCs. Requesting cardiac evaluation and possible Holter monitoring.", "relevant_history": "No prior cardiac history. Family history positive for atrial fibrillation (mother). Non-smoker. Moderate caffeine intake.", "current_medications": [ { "medication": "Sertraline", "dosage": "50mg daily"} ], "tests_performed": [ { "test": "12-lead ECG", "date": "2024-03-15", "result": "Occasional PVCs, otherwise normal"}, { "test": "CBC", "date": "2024-03-15", "result": "Within normal limits"}, { "test": "TSH", "date": "2024-03-15", "result": "2.1 mIU/L (normal)"} ], "services_requested": [ "Cardiac evaluation", "Holter monitor", "Echocardiogram if indicated"], "authorization_status": "Pending", "authorization_number": null }

referral-form.pdf

Viewer

JSON

referral_date

2024-03-18

referral_number

REF-2024-45678

urgency

Routine

patient_name

Emily R. Johnson

patient_dob

1989-07-12

patient_phone

(555) 867-5309

patient_address

456 Maple Drive, Seattle, WA 98101

patient_insurance

Aetna PPO

insurance_member_id

AET789456123

referring_provider_name

Dr. Michael Torres, MD

referring_provider_npi

1234567890

referring_practice

Seattle Family Medicine

referring_phone

(555) 234-5678

referring_fax

(555) 234-5679

specialist_type

Cardiology

referred_to_provider

Dr. Lisa Wang, MD

referred_to_npi

0987654321

referred_to_practice

Pacific Heart Specialists

referred_to_phone

(555) 345-6789

referred_to_fax

(555) 345-6790

primary_diagnosis

Palpitations

primary_diagnosis_icd10

R00.2

Secondary_diagnoses

1 item

diagnosis

icd10_code

Anxiety disorder

F41.9

reason_for_referral

relevant_history

No prior cardiac history. Family history positive for atrial fibrillation (mother). Non-smoker. Moderate caffeine intake.

Current_medications

1 item

medication

dosage

Sertraline

50mg daily

Tests_performed

3 items

test

date

result

12-lead ECG

2024-03-15

Occasional PVCs, otherwise normal

CBC

2024-03-15

Within normal limits

TSH

2024-03-15

2.1 mIU/L (normal)

services_requested

Cardiac evaluation, Holter monitor, Echocardiogram if indicated

authorization_status

Pending

authorization_number

null

Extraction you control

Define your rules. Extract exactly what you need. Define intelligent document extraction pipelines

Secure and Compliant

Fully secure. Always.

Your documents are your own and never shared for any reason. DocuPipe encrypts all documents in transit and at rest, and has undergone formal certification to become SOC‑2 type 2 and ISO 27001 certified. This ensures that the highest standards of information security are met. DocuPipe is both GDPR and HIPAA compliant.

Visit our security page

Better in every way

Experience accuracy, flexibility, and speed with DocuPipe.

Feature	DocuPipe	Textract	Google OCR	GPT
OCR printed text
Handle simple tables
Handle long documents
OCR handwriting
Nested tables
Complex forms
Crossed out text
Support for 60+ languages
AI document standardization
Speed
Document type classification
Document Splitting
Highlight information source on document
Visual Review