Medication complexity referral checklist

Referral checklist for polypharmacy risk, adverse-effect burden, or difficult medication reconciliation cases.

Last reviewed February 7, 2026

Urgency tier

Immediate emergency assessment for severe toxicity, serious acute adverse reaction, or clinical instability; referral paperwork must not delay treatment.
Expedited referral for high-risk polypharmacy or recurrent harm when currently stable.
Routine referral for structured deprescribing and optimization planning.

Minimum pre-referral workup

Complete medication reconciliation including OTC and supplements.
Current indication list with dose, duration, and recent changes.
Documented adverse events, interaction concerns, and monitoring gaps.

Referral packet checklist

Up-to-date medication list and allergies.
Relevant labs and monitoring history.
Clear referral question and recent clinical trajectory.

Pre-referral optimization tasks

Pause non-essential high-risk combinations when safe.
Reinforce warning symptoms requiring urgent reassessment.
Arrange interim monitoring until specialist review.

References

Institute for Safe Medication Practices Canada (opens in a new tab)

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