Diabetes Prevention and Education Program

1. Log-in to the Unified Landing Page at: ulp.crisphealth.org
2. Search the desired patient (First Name, Last Name, and Date of Birth are required).
3. Select the patient by clicking the box in the “Include” column on the right-hand side of the screen then access the “Referrals Web Form” by clicking the “Referrals” tab at the top of the screen.
4. Once in the “Referrals” tab, the Web Form will prepopulate with patient demographic information. Complete the following sections manually: Patient Vitals, Alternate Phone Number, and Email.
5. Select Johns Hopkins – BMD Regional Partnership from the “Organization” dropdown.
6. Select Diabetes Prevention Program
7. Note: The comment box is a required field provided for sharing pertinent patient notes.
8. Once the Web Form is complete, check the ‘Patient Consent” box then click “Submit” to send the referral.*
   *A referral has only been successfully submitted if you receive a confirmation page and/or a confirmation email from CRISP.

1. Download the appropriate referral form below:
   • Diabetes Prevention Program Referral Form
   • Diabetes Self-Management Education Referral Form
2. Complete the form and indicate any required lab results and patient notes. Ensure that patient contact information is accurate and include referring provider or staff contact information.
   • For DPP, fax completed form to 410-367-3304.
   • For DSMT, fax completed form to 410-367-2042.

   Staff will reach out if additional information is needed.

Staff will contact the patient within 48-72 hrs.