How do I add attachments to referral letters?

When sending a referral letter, you may include multiple types of attachments. You can currently include the following types:Signed and unsigned encounter notes

  • Encounter notes: Signed or unsigned encounters of any note type (SOAP or simple)
  • Lab results: Results may be signed or unsigned and may contain structured and/or unstructured data
  • Imaging results: Results may be signed or unsigned and must contain structured data, i.e. reports only, not images
  • Documents: Signed or unsigned with any assigned document type
  • Referral Note document: Clinical documents formatted to the Consolidated Clinical Data Architecture (CCDA) Referral Note document template may be generated and attached directly within the referral workflow. These documents cannot be sent to recipients via fax, as the document is in a digital XML format; they must be sent electronically. If you are sending a referral by fax, Referral Note documents will need to be printed and faxed separately
  • Continuity of Care Documents (CCDs): Clinical documents formatted to CCDA standards may be generated from the patient chart by following the guidelines here. A CCD cannot be sent to recipients via fax, as the document is in a digital XML format. If you are sending a referral by fax, CCDs will need to be printed and faxed separately

Adding referral attachments

1. Click into the Attachments field within the referral window. You will then be able to select from a list of the patient’s available attachments in the left-hand flyout pane. A notification below the attachment will indicate if it can only be sent electronically.


2. If necessary, use the two dropdown filters at the top of the Attachments flyout to further narrow down the list of available attachments.

  • Filter by time frame (for example: last 18 months):


  • Filter by attachment type (for example: Clinical Summary):


Note: At this time, referral attachments on e-faxed referrals cannot total more than 500 KB in size. The indicator above the top-right corner of the Attachments field will show the total file size. If the files exceed 500 KB, one or more of the attachments must be removed before faxing. Alternatively, if the referral recipient has a Direct address or is part of the Practice Fusion provider network, you may un-check the Send by Fax box in the referral window to send only an electronic copy of the referral. There is no attachment size limit for electronic referrals.


3. Clinical documents formatted to the Consolidated Clinical Data Architecture (CCDA) standard are XML files that contain structured and unstructured patient data and can be formatted according to various document templates, such as the Referral Note document template. If you are choosing to generate a CCDA document formatted using the Referral Note document template, the option to Generate referral note is located at the bottom of the attachments pane.

Using the dropdown menu, select the signed encounter you want to include, then click Create. The Referral Note document will be automatically added to the Attachments field.

Note: Referral Note documents cannot be sent to recipients by fax, as the document is in a digital format (XML). If you are sending a referral by fax, Referral Note documents will need to be printed and faxed separately.  

Viewing and receiving referral attachments All attachments can be sent and received electronically when sending a referral to another Practice Fusion provider or via Direct messaging.

Certain attachments, such as clinical documents, Referral Note documents and completed patient intake forms, cannot be sent/received by fax. If you have included an attachment that cannot be sent by fax, this will be noted at the bottom of the faxed referral letter (shown below). In these instances, you may print them to manually fax separately.


For more information, please see:

EHR Features

  1. How do I get started with Practice Fusion?
  2. How do I train my practice on the EHR?
  3. How do I schedule a new appointment?
  4. How do I upload documents?
  5. How do I update my appointment schedule?
  6. How can I customize my default appointment time and the appointment slots on my schedule?
  7. How do I schedule recurring appointments?
  8. How do I change appointment status in the scheduler?
  9. What is the appointment reminder process?
  10. What reports are available in the EHR?
  11. How do I send a referral?
  12. How do I export patient demographics from Practice Fusion to an Excel file?
  13. How do we integrate our product or service with Practice Fusion?
  14. How do I use the Patient Lists report?
  15. How can I access Practice Fusion on my tablet?
  16. How can I re-fax a failed fax referral?
  17. Do we receive a notification when a patient requests an appointment?
  18. Where can I change or add appointment types?
  19. How do I find a patient's past and future appointment?
  20. How do I create a block on the schedule?
  21. How is a patient notified of appointment status?
  22. Is scanning patient information into Practice Fusion legal?
  23. How do I create a custom Simple note?
  24. What is population health management?
  25. How do I run or export reports?
  26. How do I get an alphabetical list of patients?
  27. How do I add a new contact to my Directory?
  28. Using Voice Dictation on the iPad
  29. Where is Live Chat help?
  30. Practice Activity in the EHR for security audit
  31. How do I create a Help Ticket for the Customer Service team?
  32. How do I view and print my daily schedule?
  33. I customized all new colors for appointment types and now ALL my appointments are one color.
  34. How do I refer a colleague to Practice Fusion?
  35. How can we organize documents?
  36. Does Practice Fusion have the ability to import or export an HL7 file?
  37. How do I recover a deleted appointment?
  38. How do I color code the scheduler?
  39. What information will display when I print the Appointments sheet?
  40. How do I schedule time for non-provider staff?
  41. Why are my appointments missing?
  42. How can I hide inactive users in the Schedule?
  43. Why aren't patients receiving the email appointment reminders?
  44. What emails are sent to patients?
  45. How do you print a signed soap note?
  46. Is Practice Fusion secure?
  47. Can I generate a list of my specific patients?
  48. How do I delete or remove an uploaded document?
  49. What is the Family History section?
  50. How do I upload and reconcile clinical documents?
  51. Vaccination Clinical Decision Support Reminders
  52. How do I create referral templates?
  53. How do I use the Payer Report?
  54. How do I set durations for custom appointment types?
  55. How do I create custom document types?
  56. How do I delete custom document types?
  57. How do I add attachments to referral letters?
  58. What tools are available to track patients with overactive bladder (OAB)?
  59. How do I retrieve a referral if I don't have a Practice Fusion account?
  60. How can I use the Updox inbound fax feature with Practice Fusion?
  61. How can I track copays in the schedule?
  62. Is private training available?
  63. How do I use the help menu drop down?
  64. Can I use Dragon or other dictation software with Practice Fusion?
  65. What are appointment conflict notifications?
  66. How do I update an appointment's confirmation status in the schedule?
  67. What is the Prescription Report?
  68. How do I submit an idea?
  69. How do I use the Appointment report?
  70. How do I use the new Patient List Report?
  71. How do I batch export CCD files for a subset of my patients?
  72. How do I use pinned notes?
  73. How do I connect to NC HealthConnex HIE?
  74. How do I connect to Healthix Health Information Exchange?

Feedback and Knowledge Base