HOF Partnerships: Referring to Dermatology, Surgery and Others

No orofacial harmonization (HOF) professional solves everything. A patient who arrives with a suspicious skin spot, with tooth pain, with a functional bite problem, with a marked bone alteration or with a complication beyond your competence needs another pair of eyes. Knowing whom to refer to and how is part of the clinic's quality, and a network of trusted partners also protects the patient and the professional.

This guide covers when to refer, how to choose and maintain partners, how to handle the referral from the patient's side, what to record and where the ethical limit lies, especially regarding referral commissions. Board rules change: always confirm your board's current resolution and, when in doubt, ask the board.

When should you refer a patient?

Referring is not a failure. It is the result of a responsible assessment. Some common triggers:

Referral can also go in the opposite direction: you receive patients from colleagues for a specific procedure, or to complement a larger plan. The same ethical logic applies.

Who can do what? Be careful with that question

The field has regulatory disputes among boards about which professionals may perform which procedures. This guide does not answer that question, and no cooperation partner should be chosen based on "can or cannot" without checking. The right approach is for each professional to act within what their board's rules and the legislation allow, and for whoever refers to verify the partner's qualifications. To understand the scenarios by profession, see regulation of HOF at the CFO, facial harmonization and the CFM, aesthetics in nursing and the COFEN, HOF in biomedicine and the CFBM and aesthetic pharmacy and the CFF.

How do you choose partners?

A good partnership is one you would use for a family member. Practical criteria:

1. Qualification and registration with the board, confirmed on the board's own website.
2. Known ethical conduct: how they communicate risks, how they treat patients, how they handle complications.
3. Competence in the specific area you refer to, not just the title.
4. Communication: replies quickly, sends information back, does not leave the patient "in limbo".
5. Philosophy alignment: if you practice natural-looking HOF and the other person prefers very different approaches, the patient ends up in the middle.
6. Access: location, hours, insurance plans or known prices, so the patient is not surprised.
7. Compliant health-regulation setup, with a service license. See health license.

How do you handle the referral with the patient?

The way you refer changes how the patient experiences the moment. Avoid "this isn't my area" and highlight the care.

Good practices:

• Explain the reason clearly and without alarmism.
• Offer more than one name when possible, so the choice is the patient's.
• Make clear that you have no financial gain from the referral.
• Provide the referral in writing when appropriate: a summary of the reason, relevant findings, a specific question to the colleague.
• Agree on the follow-up: ask the patient to come back with the other professional's recommendations before continuing the plan.
• Do not promise that the other professional "will fix it". Describe what is likely and what is uncertain.

What should you record and share?

Every referral must go into the patient record: date, reason, to whom, what the patient was told and the reply received. This protects the patient (continuity) and the professional.

Sharing health data, which is sensitive data, requires care under the LGPD (Brazil's General Data Protection Law): clear purpose, minimum necessary, secure channel (avoid large messaging groups and unprotected personal devices) and a record of the patient's awareness. See also WhatsApp Business for the HOF clinic.

Referral commissions: where is the limit?

This is the point that causes the most problems. In several codes of ethics for healthcare professions, it is prohibited to pay or receive a commission, percentage or advantage for a patient referred or received. Brazil's Medical Code of Ethics, for example, contains a prohibition of this kind. Other professions have their own rules, with different wording and interpretations. Therefore:

• Do not agree on a percentage, split or financial "thank you" for a referral without having read your board's rule and your partner's board's rule.
• Be wary of any partnership whose logic is "earning per patient". Even if there is a legitimate form of payment for a service provided, it must truly be for the service, not for the referral.
• When in doubt, ask the board or a lawyer specializing in health law for written guidance.
• Distinguish: a professional who treats and charges for their own service is different from one who gets paid for "bringing" patients.

The same concern applies to indirect benefits: valuable gifts, trips, discounts, course trade-offs or social media exposure. The logic of patient referrals applies here: referral should arise from clinical trust, not from gain.

And when the partnership is real, with a contract?

There are legitimate arrangements between professionals: a dentist who works in a room inside another's clinic, a physician who provides services to an aesthetics clinic, a partnership between professionals for joint appointments. In these cases, the relationship is one of service provision or partnership in a company, not referral. They involve:

• a clear contract on responsibilities, timelines, payment per service and exit (see jobs and work models in HOF and hiring a professional at the HOF clinic);
• an adequate health license and responsible professional (see responsible professional of the HOF clinic);
• taxation of the arrangement, with an accountant's guidance (see individual or company in HOF);
• each party's civil liability (see liability insurance in HOF);
• physical space and rules of use (see rented room, coworking or own clinic).

If the partnership is broad, see a lawyer before signing.

How do you maintain the relationship with partners?

• Close the loop: thank the colleague and tell them what the patient did with the advice, respecting confidentiality.
• Reciprocate with quality care, not with perks.
• Meet periodically (a coffee, a clinical meeting) to align approaches and discuss cases anonymously.
• Assess the patient experience (see NPS at the HOF clinic) and adjust the partner list.
• Respect the patient's decision to go to a professional other than the one you suggested.

Hypothetical example: during an assessment, the professional notices a suspicious skin lesion near the area to be treated. They pause the procedure, explain the reason to the patient, suggest two trusted dermatologists in writing and record everything in the patient record. The patient returns three weeks later with the specialist's assessment and the plan resumes. The professional receives nothing for the referral and the patient comes to trust the clinic more.

Ethical referral checklist

Summary

Referring well is a clinical competence: recognize the limits of your practice, keep a small list of trusted partners, explain the reason to the patient, record it in the patient record and share only what is necessary, with their awareness and respecting the LGPD. Do not agree on a commission or advantage for a patient referred before reading your board's rule: several prohibit this kind of agreement. A partnership with a contract, space sharing or a company partnership is something else and requires legal, health-regulation and tax guidance.