Refer a Patient

Refer a qualifying patient to our Virtual Cardiac and Pulmonary Rehab program in less than 30 seconds. For enquiries please contact the Carda Health team at info@cardahealth.com

Carda Website Referral Form

Patient Name*
Patient Phone Number*
Format: (000) 000-0000.
Patient DOB*

MonthDayYear
Patient Email
Referral Type*

Cardiac RehabilitationPulmonary Rehabilitation
Pulmonary Diagnosis

J41.1 Mucopurulent chronic bronchitisJ41.8 Mixed simple and mucopurulent chronic bronchitisJ43.0 Unilateral pulmonary emphysema [MacLeod's syndrome]J43.1 Panlobular emphysemaJ43.2 Centrilobular emphysemaJ43.8 Other emphysemaJ44.0 Chronic obstructive pulmonary disease (acute) with lower respiratory infectionJ44.1 Chronic obstructive pulmonary disease with (acute) exacerbationJ44.89 Other specified chronic obstructive pulmonary diseaseJ44.9 Chronic obstructive pulmonary disease, unspecifiedU09.9 and R06.00 Post COVID-19 condition, unspecified
Cardiac Diagnosis

MI within the last 12 monthsStable AnginaPCICHF (with reduced EF)CABGValve Repair/ReplacementOther
Cardiac Diagnosis Code
Please check to include

Remote patient monitoring (RPM) of blood pressure and heart rate
Please check to include

Remote patient monitoring (RPM) of blood pressure and heart rate
Additional Referral Notes
Referring Physician Name*
Office Phone Number*
Format: (000) 000-0000.
Referring Physician email
Referring Signature:*
Attachments
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