Patient Referral Requirements

At Integral Wound Solutions, we are committed to providing timely, comprehensive, and medically appropriate wound care to every patient we serve. To ensure an accurate evaluation and to comply with Medicare and insurance guidelines, it is essential that all referring partners submit complete documentation at the time of referral.

Providing the full set of records allows our clinical team to establish medical necessity, verify coverage, understand the patient’s wound history, and develop the most effective treatment plan. Incomplete records may delay the patient’s care.

Required Documentation for All Referrals

To proceed with a patient evaluation, please include the following:

  • Patient Demographics / Face Sheet

    Includes full legal name, date of birth, address, contact information, emergency contact, and primary care physician.

  • Insurance Information

    A clear copy of the front and back of the insurance card(s), including Medicare, Medicaid, commercial insurance, or secondary policies.

  • Medication List

    An updated list of all prescription medications, OTC medications, and supplements.

  • Past Medical Records

    Relevant clinical notes, recent encounters, hospitalization records, specialist notes, and any documentation related to chronic conditions.

  • Past Wound Assessments & Treatment History

    Include any wound care notes, measurements, photos (if available), debridement records, graft applications, dressing changes, and progress documentation.

  • Detailed Past Medical History

    Chronic illnesses, comorbidities, surgeries, allergies, immunocompromised conditions, and any factors impacting wound healing.

Medicare-Required Documentation to Establish Medical Necessity

For Medicare beneficiaries, the following elements are essential to ensure compliance and proper medical necessity determination:

  • Clear reason for referral, including suspected or diagnosed wound type.

  • History of Present Illness (HPI) describing how long the wound has been present, how it started, and previous interventions attempted.

  • Supporting diagnoses linked to the wound (e.g., diabetes, venous insufficiency, pressure injury risk factors).

  • Relevant imaging or lab results (if available), such as vascular studies, cultures, A1C levels, or infection workups.

  • Documentation of conservative treatment already attempted (e.g., offloading, compression therapy, standard dressings) when applicable to coverage criteria for advanced treatments.

  • Skilled-need justification showing why the patient requires specialized wound care.

  • Functional and mobility status, especially for patients in home health or SNF settings.

  • Signed provider orders for evaluation and treatment, if available.

Submitting a Complete Referral Helps Us Serve Your Patients Faster

Our goal is to ensure seamless coordination of care. Once all required documentation is received, our clinical team will promptly review the case and schedule the patient for evaluation.

Thank you for partnering with Integral Wound Solutions and trusting us with your patients’ wound care needs.