Refer a Patient Complex Care Clinic

To refer your pediatric patient to the Complex Care Clinic, please complete the following steps.

1. Review guidelines
   To ensure that your patient receives the best possible care, please review the referral guidelines below and submit the requested information with the online referral form.
   • Patient must meet the minimum requirements here for consideration of admission:
     1. Referral by current PCP or subspecialist.  Self-referrals not accepted.
     2. Must meet all categories listed below:
     3. Medical Complexity
        1. Complex medical diagnoses
        2. Technology dependence – requires one
           1. Respiratory – invasive ventilation, NIPPV, tracheostomy
           2. Nutritional/gastrointestinal – gastrostomy tube, gastrojejunostomy tube, ostomies, TPN
           3. Vascular – central line (case by case basis dependent on diagnosis)
           4. Cardiac – complex cardiac support devices (LVAD)
        3. Greater than 2 core specialists that are seen on a routine basis, i.e., every 3-6 months and the specialists are actively engaged in the care plan OR
        4. Severe functional limitations that impact ADLs (inability to provide basic self-care)
     4. Live within a 75-mile radius of the clinical site
     5. Exclusions
        1. Primary mental health/behavioral health diagnosis
        2. Lives beyond 75-mile radius
        3. >17 years of age
        4. Family declines referral
     6. Clinic Overview
     7. The CCC will serve as the Primary Medical Home for the child with medical complexity and assume the role of PCP. 
     8. Services included:
        1. PCP care with Pediatrician or Nurse Practitioner
        2. Embedded care coordination teams for every patient
        3. Clinical dietitians
        4. Social Work
        5. Clinical staff experienced with children with medical complexity
        6. Child and Adolescent Psychiatrist
        7. Respiratory therapist in clinic
        8. 24 hour on-call service
        9. In person and Telemedicine appointments
        10. Well child care, routine follow up and urgent visits available
   • The Complex Care Clinic will serve as centralized provider and the ongoing Patient-Centered Medical Home for complex patients.
   • When all required information has been received, the nurse coordinator will contact the referring physician and/or patient's family once a decision is made regarding acceptance within 2 weeks.

**Please ensure that all appropriate caregivers have been notified of this referral PRIOR TO initation with the Complex Care Clinic**

2. Complete the online referral form or submit via Texas Children's Link