Complete a Quality Care Form to refer for gender-affirming surgeries

Primary care and mental health providers should collaborate to complete and submit this form for referral.

What to do

The referring provider can download the quality care from and complete it for the referral.  Please follow the instructions on the form and coordinate with the patient's care appropriate team to complete. 

Providers can use a smart phrase titled GENDERHEALTHQC to complete the form using a progress note. Stay tuned for additional instructions on how to complete the form using smart phrase with more than one provider e.g., primary care and mental health provider. 

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Last updated December 13, 2023