Make a referral

A complete referral is a fast referral.

Three ways to send it, one checklist to make it complete, and a scheduling timeline you can quote to your injured worker before you hang up.

Phone

563-421-4370

Speak directly with the work comp coordinator — best for acute injuries and urgent scheduling.

workcomp@iowaback.com

Attach the referral packet. Use secure/encrypted email when sending medical records.

Fax

563-XXX-XXXX

Fax the referral packet directly to the work comp coordinator's dedicated line.

Protecting patient information: please send medical records only by fax, secure email, or an agreed secure transfer method — never through standard unencrypted email or this website. Our team can help you set up a secure channel on the first call.

The referral packet

Seven items. Zero delays.

Referrals with a complete packet are scheduled on first contact. Missing items are the most common cause of scheduling delay — this checklist eliminates them.

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Completed referral form

Worker's name, date of birth, contact information, date of injury, and injured body region.

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Claim information

Claim number, carrier or third-party administrator, and the adjuster's name, phone, and email.

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Case manager contact

Name and contact information for the assigned nurse case manager, if one is assigned.

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Written authorization

Authorization for the evaluation from the employer or carrier — required before non-emergency care in Iowa.

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Medical records — in chronological order

Clinic notes, radiology reports, and operative reports related to the injured body region, oldest to newest.

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Imaging

The actual studies (disc or electronic transfer), not just the reports, whenever available.

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Functional job description

The physical demands of the worker's position — the foundation for accurate restrictions and return-to-work planning.

Scheduling timelines

What to tell your injured worker.

24–48 hrs

ACUTE INJURIES
Sudden or serious injuries are triaged and scheduled within one to two business days of a complete referral.

5–7 days

ROUTINE REFERRALS
All other referrals — including second opinions, IMEs, and ratings — scheduled within five to seven business days.

Downloads

Referral documents.

Work Comp Referral Form

The single-page intake form covering worker, injury, claim, and authorization details.

Download coming soon · available by request today

Referral Requirements Sheet

A one-page version of the checklist above — handy for adjusters and HR teams making their first referral.

Download coming soon · available by request today

A complete referral is a fast referral.

Seven items. Zero delays.

What to tell your injured worker.

Referral documents.

Refer by phone right now.