Presently, specific specialty referrals are made under agreement with PacMed and Swedish Consultants to abide by our sliding scale. Residents are expected to provide detailed referral letters or forms. Clinic referrals are handled in the same way as any other referral in the practicing community. Learning to write consultation letters is an important family medicine skill. They will be reviewed, initialed and discussed by team leaders prior to scheduling appointments. The consultant is expected to reply by letter and set forth his/her findings and recommendations. This then becomes part of the patient's permanent clinical record.

1. When a consultant decides the patient should be admitted to the hospital electively, s/he will communicate directly with the referring resident physician. On elective admissions, the resident and consultant should work out a mutually agreeable admission date.

2. Clinic patients are admitted to the hospital by the FP Service under the name of the FP faculty on the service. Occasionally patients will be admitted to critical care services (ICU, CCU, SCN) and patients will be rounded on by PMD faculty and resident on FO service as a social manner and they will resume primary care once the patient is no longer critical.

3. Resident physicians on FP service are expected to do the admission H & P on all electively admitted clinic patients, writing orders and following the patient's course in the hospital under the guidance of the consultant and FP service attending. The PMD residents will write social notes and contribute to care planning with the team as much as they are available.

4. In the case of surgery, the resident must be notified and will be expected to assist the surgeon, or find a substitute in the event the resident cannot be present. On elective surgery, the consultant and the resident should work out a surgery time and date that allows him/her to participate.

5. Discharge summaries on all clinic and residency patients and post-hospital plans are the duty of the resident in collaboration with the consultant.

By following these procedural steps, we hope to provide the maximum in learning and teaching opportunities between residents and faculty consultants and to provide the optimum in patient care.