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PCA Cardiology & Vitasigns: Advancing Health Together

Please complete the form below for Remote Patient Monitoring & Chronic Care Management new patient referrals.

Vitasigns
Weight Scale
Referral Information Form

Diagnosis #1
Brief Description
Diagnosis #2
Brief Description
Diagnosis Other
Brief Description
Patient doesn’t have an ICD-10 code and is not yet approved by the doctor, so the buttons will work as follows:
  • Submit: Updates the patient’s ICD-10 code only.
  • Approve & Submit: Updates the patient’s ICD-10 code and records doctor approval to proceed with contacting the patient.