The Employees' State Insurance Corporation (ESIC), vide File No. U-16/30/649/2023-SST dated 23 June 2026, has issued a revised Standard Operating Procedure (SOP) for the P1 Referral Process applicable across all ESI hospitals, medical colleges, and healthcare institutions. The new SOP introduces a standardized and technology-driven referral mechanism to ensure timely, transparent, and accountable patient transfers. It mandates real-time patient photograph uploads, verification of ESIC eligibility, clearly documented clinical diagnoses, multi-level approval by the treating doctor, Head of Department, and Hospital Head, as well as signatures from the Dean or Medical Superintendent. The guidelines also require secure handling of system credentials, mandatory attachment of medical records and insurance documents, digital signatures for applicable referrals, fixed daily processing timelines, and enhanced scrutiny through surprise audits to detect irregular referral patterns. ESIS hospitals and dispensaries have also been directed to prioritize referrals to ESIC hospitals and medical colleges wherever feasible. Healthcare administrators, medical officers, and ESIC institutions should review the SOP carefully to ensure full compliance with the revised referral procedures.