physicians

What is needed to initiate a MNT referral?

There are two common ways patients are referred to Medical Nutrition Therapy Northwest dietitians.

1. The physician faxes a referral form to Medical Nutrition Therapy Northwest, identifying the patient and his or her diagnosis and a copy of the supporting lab data. Our office will contact the patient and arrange the MNT appointment.

Click here for a Physician Referral Form

Click here for Physician Referral Form Instructions/Example

2. The patient contacts Medical Nutrition Therapy Northwest asking for an appointment. Our office will contact the patient’s physician and ask for referral documentation identifying the patient and his or her diagnosis and a copy of the supporting lab data.

At your request Medical Nutrition Therapy Northwest can supply you with the appropriate referral forms and instructions. Simple photocopies of these forms are always acceptable with an original signature. You can fax this form to Medical Nutrition Therapy Northwest, but the original must be stored in the patient’s record.

As a referring physician, what do you receive?

Following each MNT session, the dietitian prepares the MNT Patient ProfileTM behavioral status and MNT session notes for the patient’s chart, sending or faxing a copy to the referring physician. In addition, upon the physician's request, we will make available any other appropriate data collected while providing MNT. Medical Nutrition Therapy Northwest can also provide the outcomes statistics for any single physician's or clinic's patients as a whole group. These may include descriptive statistics for nutrient intake, clinical testing results, or behavioral outcomes status. (Our data management procedures ensure that all data collected by Medical Nutrition Therapy Northwest is securely held and compliant with latest HIPAA confidentiality guidelines.)