Referral Checklist for Advanced Wound Care


Referring a patient for mobile advanced wound care is fast and simple. Just use the below checklist and make a referral through our online patient referral portal to get a patient the wound care they need.

required documentation

We only need a few pieces of required documentation to start processing a referral.

  • Patient demographic information
  • Primary and Secondary insurance information
    • Copies of insurance cards are extremely helpful
  • Past 3 weeks of documentation of:
    • Wound measurements
    • Wound treatment history

helpful documentation

This information is extremely helpful and allows our team to more efficiently process the referral.

  • Wound photos
  • Applicable labs for last 3 months (If diabetic most recent HbA1c)
  • History and Physical
  • Post surgical wounds: order for Mendota health to evaluate and treate.*
  • Any previous ABI/Vascular/Imaging


*Surgical wounds created in the last 90 days must have an order from the surgeon approving Mendota Health to evaluate and treat due to a 90-day global period.

Patient Referral Checklist for Mobile Advanced Wound Care