FOR HEALTHCARE PROFESSIONALS

Refer a Patient

Thank you for trusting THE SALONI NUTRITION with your patient’s care. I provide evidence-based, personalized nutrition care designed to complement the patient’s treatment plan and support meaningful, sustainable improvements in health.

Refer online or by fax — whichever works best.

Submit a Referral Online

Complete and electronically sign the secure, HIPAA-compliant referral form in just a few minutes.

START ONLINE REFERRAL

Fax a Referral

Download and complete referral form, then fax it to 925-540-5669. A provider signature is required on the faxed form.

DOWNLOAD REFERRAL FORM

Referral Information

For Medical Nutrition Therapy: Please include the patient’s diagnosis and ICD-10 code, treatment objective or diet order, and referring provider’s signature. Relevant clinical records may be included when available.

Submission of a referral does not guarantee insurance coverage. Please do not send protected health information through regular email.

Already Have a Referral Process?

If your practice uses its own referral form, that’s fine – there’s no need to use ours. Simply fax it to 925-540-5669 and make sure it includes:

Patient’s full name, date of birth and phone number
Diagnosis and ICD-10 code
Requested Care: nutrition counseling or medical nutrition therapy (MNT)
Treatment objective or diet order
Referring provider’s name, NPI and contact information
Provider signature and date

When available, please also include:

What Happens Next

Referral Reviewed

I review the referral for completeness and confirm that the patient’s needs align with the services offered.

Patient Contacted

I contact the patient within 3 business days to discuss scheduling, insurance benefits and next steps.

Care Coordinated

I provide individualized nutrition care that supports the patient’s treatment plan and, with the patient’s consent, share relevant updates with the referring provider.

Insurance coverage is determined by the patient’s health plan and cannot be guaranteed.

FOR REFERRING PROVIDERS

Areas of Nutrition Care

Nutrition care is available across a broad range of clinical areas and health needs, from chronic condition management to specialized nutrition support across the life span. Select a service area below to view common ICD-10 codes for referral reference.

The codes shown are common examples and are not exhaustive. Please use the most specific ICD-10 code supported by the patient’s diagnosis and clinical documentation.

VIEW ALL NUTRITION SERVICES

Weight Management

Common ICD-10 codes

E66.3 — Overweight
E66.811–E66.813 — Obesity, classes 1–3
E66.9 — Obesity, unspecified
R63.6 — Underweight
R63.4 — Abnormal weight loss
Z71.3 — Dietary counseling and surveillance

Blood Sugar & Diabetes Management

Common ICD-10 codes

R73.03 — Prediabetes
R73.09 — Other abnormal glucose
E10.9, E10.65 — Type 1 diabetes without complications or with hyperglycemia
E11.9, E11.65 — Type 2 diabetes without complications or with hyperglycemia
E16.2 — Hypoglycemia
O24.410 – Gestational diabetes mellitus – Diet controlled

Women’s & Hormonal Health

Common ICD-10 codes

E28.2 — Polycystic ovarian syndrome
N97.9 — Female infertility, unspecified
N92.6 — Irregular menstruation, unspecified
N95.1 — Menopausal and female climacteric states
O26.1- — Low weight gain in pregnancy; select the applicable specific code
Z39.2 — Encounter for routine postpartum follow-up

Digestive & Gastrointestinal Health

Common ICD-10 codes

K58.0, K58.1, K58.2, K58.9 — Irritable bowel syndrome
K21.9 — Gastroesophageal reflux disease without esophagitis
K90.0 — Celiac disease
K50.- — Crohn’s disease; select the applicable specific code
K51.- — Ulcerative colitis; select the applicable specific code
K59.00 — Constipation, unspecified
R19.7 — Diarrhea, unspecified
K31.84 — Gastroparesis
K90.9 — Intestinal malabsorption, unspecified

Renal Health

Common ICD-10 codes

N18.1, N18.2 — Chronic kidney disease, stages 1–2
N18.30, N18.31, N18.32 — Chronic kidney disease, stage 3, 3a or 3b
N18.4, N18.5 — Chronic kidney disease, stages 4–5
N18.6 — End-stage renal disease
Z99.2 — Dependence on renal dialysis
Z94.0 — Kidney transplant status

Nutrition Across the Life Span

The appropriate code will depend on the patient’s age, diagnosis and clinical reason for referral. Use the diagnosis-specific code from the applicable clinical category whenever possible.

Common supporting ICD-10 code