For case managers and care coordinators
What belongs in a concise provider referral brief?
A service brief should let a provider understand the request and identify what it needs to check. Include the service being considered, location, proposed schedule, relevant preferences and current authorization status. Keep unanswered questions visible and share detailed records through the agreed intake process when needed.
Lead with the request
State why you are contacting this provider now. Distinguish a general fit inquiry from a referral ready for review or a question about a previously discussed schedule. Include your role and the appropriate follow-up contact.
Use the person’s priorities to give the request context. A brief that lists only hours and a waiver name can leave the provider guessing about the purpose of the support.
Separate known information from assumptions
Mark service authorization, proposed hours, timing and staffing as separate fields. Use “pending” where appropriate rather than treating an anticipated approval as complete. Identify the question that the provider must answer before the referral can move forward.
Keep the initial brief proportionate to the decision. Do not include a full private history where a short service-fit description will do. Ask how additional documents should be provided and confirm permission to share them.
Make a response easy to act on
End with a specific request: confirm whether the team can review the service and schedule, identify missing information, or name the appropriate intake contact. Keep the provider’s answer with the date and contact so it can be distinguished from an older discussion.
The Clemens Health referral form collects contact relationship, client basics, requested services and optional documents. This brief supplements that process; it does not replace assessment or authorization.
Provider referral service brief
Download this editable worksheet, add your notes, and bring it to the relevant planning conversation. Leave unknown details blank and identify who can confirm them.
Download worksheet (.txt)- Request and purpose
- Which service and support goal are being discussed, and why now?
- Location and schedule
- Where would support occur and which days or hours are proposed?
- Confirmed information
- What is authorized or otherwise confirmed, and by whom?
- Person’s preferences
- What communication, worker-fit or scheduling preferences affect the discussion?
- Requested response
- What exactly should the provider confirm or clarify next?
An optional discussion tool, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.
Illustrative planning example
A case manager sends a brief for IHS with training with the learning goal, general location and proposed afternoons. The brief clearly says schedule confirmation is pending and asks the provider to identify any information needed to assess fit.
This example is invented to explain the worksheet; it is not a client story or a promised outcome.
Your next step
Use the brief to prepare the referral, then send information through the provider’s agreed intake channel. Track the specific response requested rather than treating form submission as acceptance of the arrangement.
For a conversation with Clemens Health about your Twin Cities location, call (651) 354-1196 or send a referral. Service fit, authorization, and staffing need to be confirmed.
Minnesota resources
State resources explain program rules. The worksheet and examples are Clemens Health planning aids. Links were checked October 5, 2026; follow the current state guidance for eligibility and service questions.