Clemens Health | Referral document inventory and correction log
Updated 2026-10-05 | (651) 354-1196

Record document identities and status, not unnecessary personal content. Use your organization's approved sharing, permission and records procedures.

Decision supported
What does the recipient need to decide?
Illustrative entry: Whether the requested service and schedule fit the referral.
Your notes: ________________________________________

Requested document
What exact record did the provider request?
Illustrative entry: Current support document identified by title.
Your notes: ________________________________________

Current version
Who issued it, when, and for which period?
Illustrative entry: Issuer and date copied from the actual record.
Your notes: ________________________________________

Recipient and route
Who should receive it and through what agreed method?
Illustrative entry: Verified intake contact and established transfer route.
Your notes: ________________________________________

Permission check
Which applicable sharing process has been followed?
Illustrative entry: Record completion under the relevant procedures, not a blanket assumption.
Your notes: ________________________________________

Transmission and receipt
What was sent and what acknowledgment exists?
Illustrative entry: Sent on recorded date; receipt confirmed, review still open.
Your notes: ________________________________________

Correction or missing item
What is unresolved and who owns it?
Illustrative entry: Previous authorization copy needs replacement by the issuer.
Your notes: ________________________________________

Decision status
What happened after document review?
Illustrative entry: Provider requested one clarification; no start confirmed.
Your notes: ________________________________________

Illustrative example
A case manager learns that a referral included a previous authorization period. The provider has already acknowledged receipt. The inventory shows the exact title and date of the outdated copy. The case manager obtains the current record, identifies the replacement clearly and confirms that the reviewer has it. They do not interpret the original acknowledgment as a completed review. The tracker records the correction and the outstanding decision without copying the person's detailed history into another spreadsheet.

Next step
Confirm the next decision and required records with the receiving provider, then maintain one concise inventory of current documents and open items.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.