How to Fill Out and Submit the UCD Referral Intake Form

To refer a patient to UC Davis Health, complete the UC Davis referral intake form online at physician-referral.ucdmc.ucdavis.edu and submit it through that web form, through the PhysicianConnect portal, or through Care Everywhere Referrals Management (CERM) if your practice uses Epic. As of January 1, 2026, fax submissions are being phased out, so these three digital channels are the standard paths into specialty care.¹ The form gathers referring provider details, patient demographics, insurance, and clinical documentation so the intake team can triage the request and route it to the right specialist.

Gather Everything Before You Open the Form

Start with the UC Davis Health Specialty Referral Guidelines, last updated February 20, 2026. That document lists the records and authorized codes each specialty department expects, and checking it first heads off the two most common causes of delay: missing documentation and unsupported diagnosis codes.¹

The minimum package your office should have ready:

The completed electronic referral intake form.
Recent clinical notes and test results — history and physical, well-check records, imaging, and labs relevant to the referral reason.
A copy of the patient’s insurance card or plan details, with coverage confirmed against UC Davis Health’s accepted plans.
If prior authorization is required, the approved CPT codes, number of approved visits, and the authorization date range.¹

Supporting records are not optional. The form warns that any referral submitted without attached records or a Care Everywhere date of service will be denied outright.² If your practice runs Epic with Care Everywhere enabled, the intake team can pull records electronically, but only if you supply the date of service so they know which encounter to retrieve.

Filling Out the Form

The form is split into two blocks. The top captures the referring provider’s information; the bottom captures the patient’s details and the clinical reason for the referral.

Referring Provider Section

Enter your last name, first name, degree, license number, and National Provider Identifier (NPI). Then your office or facility name, a contact person in your office, that contact’s direct phone number, office fax, office address, and office email.² Get the NPI and contact phone right. When the intake team has questions, they call the contact listed here.

Patient Section

The patient block asks for first and last name, date of birth, gender, Social Security number, phone number, address, and a patient or guardian email.² Verify spelling and date of birth. Errors here create duplicate records in Epic and delay scheduling.

Two follow-up questions ask whether your organization uses Epic and whether you use Care Everywhere Referrals Management. Those answers tell UC Davis Health how to exchange clinical data with your office.

Clinical Details

Enter the clinical reason for the referral, relevant ICD-10 diagnosis codes, and attach supporting records. ICD-10 codes are required under HIPAA for all covered entities and serve as the standardized way to communicate the patient’s diagnosis for both clinical triage and insurance billing.³ Fill in the date of service that corresponds to the records you’re attaching, and indicate whether you’re requesting a one-time consultation or ongoing specialty management.

Before you submit, you’ll acknowledge that all referrals are reviewed for medical necessity and service line capacity and that submission does not guarantee acceptance.²

Choosing a Submission Channel

All three channels feed the same intake team. Which one you use depends on what your office already runs.

The Electronic Intake Form

The most direct route. Go to physician-referral.ucdmc.ucdavis.edu, fill in the fields, attach records, submit. The site uses end-to-end encryption, so protected health information stays secure in transit.¹ This works regardless of what EHR your office uses.

PhysicianConnect

PhysicianConnect is UC Davis Health’s secure online portal, built on Epic’s web-based electronic medical record system. It gives referring providers direct visibility into the patient’s UC Davis Health record and lets you submit and track referrals from within the platform.¹ New users register through a DocuSign enrollment form linked on the PhysicianConnect page, and the portal is at physicianconnect.ucdmc.ucdavis.edu. Technical help is available around the clock at 916-734-4357.⁴

Care Everywhere Referrals Management

If your practice already uses Epic, CERM lets you send the referral straight from your own EHR. Address it to “UCD Incoming Electronic Referrals” within CERM.² You can also track status inside your own system. For CERM setup questions, email PhysicianLiaisons@health.ucdavis.edu.¹

Urgent Referrals Take a Different Path

Do not use the electronic form for acute-care transfers, direct admissions, or urgent consults. Call 800-4-UCDAVIS (800-482-3284) and choose Option 1 to reach the referral center directly.¹ Urgent self-referrals from patients are not accepted; patients need an urgent referral from their primary care provider.

What Happens After You Submit

A clinical reviewer assesses the referral for medical necessity based on the ICD-10 codes, clinical notes, and attached records. As one benchmark, the surgery department asks providers to allow up to 48 hours for processing.⁵ Times vary by specialty, and incomplete paperwork or unresolved clarifications extend them.

To check status, contact the specialty care service directly, log in to PhysicianConnect, or check inside CERM if your practice uses Epic.¹ For general referral questions during business hours, call 800-4-UCDAVIS (800-482-3284), Monday through Friday, 8 a.m. to 5 p.m.

Under California’s timely access standards, health plans must provide non-urgent access to a specialist within 15 business days.⁶ For services requiring prior approval, plans generally must approve or deny within three to five days, and an urgent appointment for a service needing prior approval should be scheduled within 96 hours.⁷

Why Referrals Get Denied or Delayed

The fastest way to get a referral bounced is submitting it without supporting medical records. The form is explicit: no attached records and no Care Everywhere date of service means automatic denial.² Beyond that, any incomplete information the intake team has to chase down slows processing.¹

Other frequent stumbling blocks:

Wrong or missing ICD-10 codes. If the diagnosis code doesn’t match the specialty being requested, the triage team has to follow up.
Missing prior authorization. When the patient’s insurance requires it and the referral arrives without it, scheduling stalls.
Skipping the Specialty Referral Guidelines. Each department has specific record and code requirements, and not checking is the most avoidable mistake.
Unaccepted insurance. UC Davis Health does not accept every plan. Verify coverage before submitting so the patient isn’t told days later.

Referrals are also reviewed for service line capacity, so a clinically appropriate referral may still be declined if the requested specialty is full. The acknowledgment on the form spells this out: submission is not a guarantee of acceptance.²

1
UC Davis Health. Patient Referrals
2
UC Davis Health. UC Davis Health Referral Intake Form
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Centers for Medicare & Medicaid Services. ICD-10
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UC Davis Health. PhysicianConnect
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UC Davis Health. UC Davis Health Department of Surgery – Appointments and Referrals
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Department of Managed Health Care. Timely Access to Care
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Department of Managed Health Care. Referrals and Approvals