--- title: Super-Utilizer Intervention Referral Form for Care Coordination Teams | Paperform description: Comprehensive referral form for care coordinators to refer high-cost, frequent hospital users with complex needs to intensive super-utilizer intervention programs. Streamline high-risk patient care management. url: "https://paperform.co/templates/care-coordination-to-super-utilizer-intervention-referral-form" type: static generatedAt: "2026-04-04T00:43:22.734Z" --- [← Back to free form templates](/templates/) ![Care Coordination to Super-Utilizer Intervention Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/care-coordination-to-super-utilizer-intervention-referral-form.png) [Preview](https://_preview.paperform.co/ai-template/care-coordination-to-super-utilizer-intervention-referral-form) [Use this template for free](/create?ai-template=care-coordination-to-super-utilizer-intervention-referral-form) [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/) About this free form template ### Streamline High-Risk Patient Referrals with Paperform Care coordination teams working with super-utilizers—patients with frequent hospitalizations, high healthcare costs, and complex social needs—need a streamlined way to refer these individuals to specialized intervention programs. This **Care Coordination to Super-Utilizer Intervention Referral Form** provides a structured, comprehensive solution for healthcare providers, care managers, and social workers to identify and refer high-risk patients for intensive care management. Built specifically for healthcare organizations, ACOs, managed care programs, and community health centers, this template captures critical clinical data, utilization patterns, social determinants of health, and care gaps that intervention teams need to create effective, patient-centered care plans. #### Why Paperform for Healthcare Referrals? Paperform's conditional logic ensures referring providers only see relevant questions based on patient complexity, while calculation fields can automatically flag high-risk indicators. The form's professional, on-brand design helps maintain trust across provider networks, and embedded consent language keeps everything compliant. Once submitted, **[Stepper](https://stepper.io)** can automatically route referrals to the appropriate intervention team, create tasks in your care management platform, send notifications to care coordinators, and update patient records in your EHR—eliminating manual data entry and ensuring no high-risk patient falls through the cracks. For organizations managing provider agreements or intake contracts, **[Papersign](https://papersign.com)** can handle eSignature workflows, keeping all documentation linked to the original referral for complete audit trails. Trusted by healthcare organizations nationwide, Paperform is SOC 2 Type II compliant with robust data security—providing the reliability and professionalism care coordination programs demand. --- **Note:** This form is designed for care coordination workflows and is not HIPAA compliant as configured. Healthcare organizations should review data handling practices and implement appropriate Business Associate Agreements as needed. 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Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Healthcare Population Health Analytics Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/healthcare-population-health-analytics-referral-form.png) ### Healthcare Population Health Analytics Referral Form A comprehensive referral form designed for healthcare providers to submit patient referrals with integrated risk stratification, care gap analysis, and data-driven intervention recommendations for population health management.](/templates/healthcare-population-health-analytics-referral-form/) [![Primary Care to Cultural Competency Health Center Referral 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