Refer a Patient — Co-Management

For partner clinics with a co-management arrangement with Cardiowell 360: refer a patient into remote monitoring and care-management support (RPM, RTM, CCM, PCM, APCM, or CPT 99091 data review). A member of our team reviews every referral and follows up directly.

Prefer a different referral method?

Fax or E-Fax: 833-973-0747

EHR: email referrals@cardiowell360.com for instructions

Referring clinic

Medical Provider's Name *

Practice / organization *

NPI (if you have one handy)

Phone

Fax

Patient

First name *

Last name *

Date of birth *

State *

Patient phone

Patient email

Medicare Beneficiary Identifier (MBI) (if applicable and known — not required to refer)

Co-management details

Patient's payer

Co-management arrangement (e.g. existing agreement reference, if applicable)

Notes for our care team

Supporting documents

Attach face sheet, chart notes, recent readings, or a referral letter (PDF, JPG, PNG, or TIFF — up to 5 files total, 25 MB each)

Insurance information

Attach scans of health insurance cards (PDF, JPG, PNG, or TIFF — up to 5 files total, 25 MB each)

Consent

I confirm the patient (or their authorized representative) has consented to being contacted by Cardiowell 360 about this referral. *

What happens after you refer a patient?

Review

Our team reviews the referral and confirms program fit and coverage.

Outreach

We contact the patient directly to explain the program and get them enrolled.

Coordination

We coordinate with your practice on an ongoing basis under the co-management arrangement.