Working with doctors - referrals and documentation
A patient with shoulder pain walks into Mr Rafał's practice and asks outright: "Do I need a referral from a doctor for you to see me?" Mr Rafał knows that under…
A patient with shoulder pain walks into Mr Rafał's practice and asks outright: "Do I need a referral from a doctor for you to see me?" Mr Rafał knows that under NFZ (Poland's National Health Fund) a referral used to be mandatory, but in a private practice patients come to him "off the street." He isn't entirely sure, though, where his professional independence ends and where he must rely on a doctor's diagnosis - or how to document all of this.
The relationship between a physiotherapist and a doctor has changed significantly since the Act on the Physiotherapist Profession came into force. In this article we'll explain when a referral is needed, what a physiotherapist's professional independence consists of, and how to document cooperation with doctors.
A physiotherapist's professional independence
The Act on the Physiotherapist Profession (Journal of Laws 2015, item 1994) made the physiotherapist an independent medical profession. This was a landmark change: a physiotherapist can independently carry out a functional assessment, plan and conduct therapy, choose methods, and evaluate its outcomes.
In practice this means that in a private practice, a patient can come directly to a physiotherapist, without a referral from a doctor. The physiotherapist independently assesses the patient's condition within the scope of their competence.
Independence does have limits, though - a physiotherapist doesn't make a medical diagnosis or treat conditions outside their competence. When symptoms suggest a problem requiring medical diagnostics (e.g. "red flags"), it's the physiotherapist's duty to refer the patient to a doctor.
When a referral is needed
It depends on the funding model:
| Situation | Doctor's referral |
|---|---|
| Private physiotherapy | Generally not required |
| Physiotherapy under NFZ | Usually required |
| Patient with "red flags" | Referral to a doctor is necessary |
| Continuing post-operative therapy | Worth obtaining documentation from the doctor |
Under NFZ, outpatient physiotherapy usually requires a referral issued by a doctor covered by health insurance, and the referral must be registered at the facility within a specified deadline. In the private model, there's no such requirement.
What are "red flags"
These are warning symptoms where a physiotherapist should refer the patient to a doctor instead of continuing therapy, e.g.:
- Sudden, severe pain with no injury
- Neurological symptoms (sensory disturbances, weakness)
- Unexplained weight loss
- Fever, signs of infection alongside spinal pain
- Suspected fracture or tumour changes
Recognising a red flag and referring the patient to a doctor is an expression of responsible independence, not a limitation of it. This fact should be noted in the documentation.
Documenting cooperation with a doctor
Correct documentation protects you legally and improves therapy. It should cover:
- The referral (if any) - attached to the patient's record, registered on time under NFZ
- Documentation from the doctor - imaging results, surgical reports, recommendations
- A note on referring the patient to a doctor - if you detected a red flag
- Correspondence / feedback to the referring doctor, if you're cooperating
- Patient consent to exchanging information with the doctor (GDPR)
GDPR when exchanging information with a doctor
Passing a patient's data to a doctor is processing a special category of data. It's usually done on the basis of a medical purpose (GDPR Article 9), but it's worth having the patient's consent to the exchange of information, especially when it concerns a doctor outside your own facility. The channel used must be secure.
[Solo] Example - solo practice: A patient after ligament reconstruction brings a surgical report and recommendations from an orthopaedic surgeon. You scan them into the patient's record and run therapy according to the recommendations. If you notice something concerning, you refer the patient back to the orthopaedic surgeon and note this in the record.
[Group] Example - group practice: The practice cooperates with a nearby orthopaedic clinic. A procedure is in place: when admitting an NFZ patient, reception registers the referral on time, and the treating therapist sends the doctor feedback on progress - always with the patient's consent and through a secure channel.
NFZ referral - registration deadline
If you work under NFZ, remember that a referral for outpatient physiotherapy must be registered at the facility within a specified deadline from the date it was issued (the deadline is set by NFZ regulations). After that deadline, the referral may lose validity. Reception should keep track of these deadlines.
Common mistakes
- Refusing to see a private patient "without a referral," even though one isn't required
- Continuing therapy despite red flags instead of referring to a doctor
- Missing documentation from the doctor for post-operative therapy
- Sharing information with a doctor without patient consent or a secure channel
- Missing the NFZ referral registration deadline
How to build good cooperation with doctors
Cooperation with doctors isn't just an obligation - it's also a genuine way to grow your practice. Family doctors, orthopaedic surgeons, neurologists, and rheumatologists constantly refer patients for rehabilitation - if they know and trust your work, you'll become their natural go-to address.
A few practical rules:
- Send feedback - a short summary of a patient's progress builds a doctor's trust and shows professionalism
- Respect post-operative recommendations - for patients after surgery, stick to the protocol set by the operating surgeon
- Flag concerning symptoms - if you notice something during therapy that needs diagnostics, inform the doctor
- Take care of GDPR - every exchange of data through a secure channel and with patient consent
Cooperation built on documentation and mutual respect can be a more effective source of patients for a practice than advertising.
Frequently asked questions
Does a patient need a referral to see a physiotherapist?
In a private practice, generally not. The Act on the Physiotherapist Profession made the physiotherapist an independent medical profession, so a patient can come directly. Under NFZ, outpatient physiotherapy usually requires a referral from a doctor covered by health insurance.
When must I refer a patient to a doctor?
When "red flags" appear - warning symptoms beyond a physiotherapist's competence, e.g. neurological symptoms, sudden severe pain with no injury, fever alongside spinal pain, or suspected fracture or tumour changes. The referral to a doctor and its justification should be noted in the documentation.
How long is an NFZ physiotherapy referral valid?
A referral for outpatient physiotherapy under NFZ must be registered at the facility within a specified deadline from the date of issue. After that deadline, the referral may lose validity. The exact deadline is set by NFZ regulations - it's worth having reception track it.
Can I share a patient's data with a doctor?
Yes, for a medical purpose (GDPR Article 9), but through a secure channel and, ideally, with the patient's consent to the exchange of information, especially with a doctor outside your own facility. It's worth noting the fact that data was shared in the documentation.
CTA: Want ready-made templates for documenting cooperation with doctors - a consent to exchange information, a note on referring to a doctor, and GDPR clauses? The STANDARD package includes a full set of documents for a physiotherapy practice. See FizjoReady packages →
Related articles:
- Medical records in physiotherapy - what's mandatory
- Patient consent to a physiotherapy procedure - template
- NFZ vs private - billing models for a physiotherapy practice