# Referral follow-up design worksheet

Ethon AI · Revised September 5, 2026

Blank administrative planning aid. Use fictional examples only.
Do not use this file as a patient referral register.

## Agree each status

| Status | Next action | Responsible role | Evidence to advance | Review point | Exception route |
| --- | --- | --- | --- | --- | --- |
| Waiting for a required record | | | | | |
| Ready for scheduling | | | | | |
| Unable to reach patient | | | | | |
| Appointment offered | | | | | |
| Appointment confirmed | | | | | |
| Awaiting completion evidence | | | | | |

These are example labels, not prescribed clinical or program requirements.
Replace them with the states your organization approves.

## Handoff exercise

1. Choose a fictional referral with a missing record.
2. Record the last action, responsible team, and next review point.
3. Ask another coordinator to identify the next action without a verbal briefing.
4. Walk through successful contact, no response, and a request for staff.
5. Record ambiguities and revise the status definitions.

## Review before implementation

- [ ] Required information confirmed by responsible clinical/scheduling teams.
- [ ] Contact channels and follow-up rules approved.
- [ ] Exceptions have named roles and review points.
- [ ] No automated attempt silently marks a referral complete.
- [ ] Access and storage use the organization's approved systems.
- [ ] Waiting time and working time have separate definitions.