When a Referral Is Outside Your Scope
Saying no can feel heavy. You can still be helpful without taking a case that does not fit your scope, schedule, license, or model. A clear handoff protects the patient, your practice, and your energy.
The three-sentence warm handoff
Use this anytime needs fall outside your lane. Keep it short, kind, and useful.
Name what you heard and validate the need.
State your scope and the limit.
Offer the next step and keep the door open.
Patient version (example)
“From what you shared, you are seeking weekly EMDR trauma therapy. My practice focuses on medication management and brief therapy, so I am not the best fit for that need. I will send three EMDR providers taking new patients and, if you would like, I can stay available for medication care once you are settled.”
Referrer version (example)
“Thank you for thinking of me. This patient needs neuropsych testing to clarify diagnosis, which I do not provide. I will share two testing clinics with 4–6 week availability, and I am happy to co-manage once results are back.”
Small moves that make handoffs work
Referral receipt. After the call, send a portal message with 3 aligned providers, phone numbers, expected wait times, what to bring, and “If you cannot connect within 7 days, tell me and I will share another option.”
Track out-of-scope reasons. For one quarter, log date, reason, population, who you referred to, and whether they landed. Patterns guide future training or partnerships.
Keep a live list. Quarterly, ask top partners, “Are you taking new patients?” and “Which populations are you prioritizing?” Update languages, insurance, modalities.
Close the loop. When a patient lands, send the referrer a brief update and your co-management offer.
Fast scope map
When unsure, scan four areas:
Clinical need: safety, level of care, diagnostic clarity
Legal and license: state lines, collaboration requirements
Model fit: visit length, therapy frequency, controlled substance policies
Access: insurance dependency, language, mobility
If two or more do not align, refer with specifics. If one is off but others fit, consider a “not yet” plan with conditions.
Documentation that protects you
Use a brief consult note each time:
Reason for inquiry and goal in their words
Scope limit you stated
Resources provided and how you sent them
Safety guidance given
Follow-up plan and time frame
Special cases to plan ahead
Controlled substances without records
“I cannot prescribe stimulants without records and a full evaluation. Here are two testing options and one skills group. After testing, send the report, and we can decide together.”
Active substance use with unstable housing
Share local program intake days and a same-day contact line. Bridge only if safe and permitted. Document limits.
Out-of-state telehealth
“I am only licensed to treat patients in California. Here are two directories filtered to your state and insurance. If you want city-specific options, tell me and I will look up a few.”
Boundaries that keep the door open
“Once weekly therapy is in place, I can support medication care.”
“After testing, send the report and we can book an evaluation.”
“If your schedule shifts to daytime, reach back out.”
Build the habit in one week
Day 1: Write your three-sentence handoff and save as a template.
Day 2: Add a referral receipt message to your portal.
Day 3: Refresh the referral list and wait times.
Day 4: Add a consult note template to your EHR.
Day 5: Role-play two tricky scenarios.
Day 6: Post a “How I Work” page that names your scope.
Day 7: Review out-of-scope calls and send clean follow-ups.
If you’re feeling stuck or unsure where to start, come join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.