Proposal Overview
Thank you for the opportunity to work with PURE on automating the referral intake process across your locations.
Referrals reach PURE today by fax through GoTo, by email and by phone, are forwarded to a central inbox, and are then read and re-keyed by hand into a spreadsheet. Staff then chase the patient by telephone until the practice intake form is completed. The work is accurate only because people are careful, and it does not scale with referral volume.
This proposal sets out a system that removes the manual step end to end. Inbound faxes are pulled straight from GoTo and referrals from your existing inbox, the patient details are extracted, and they are written into the Google Sheet your staff already work from. The patient is then contacted automatically — an AI voice call, a text message and an email — each carrying a link to PURE's own JotForm intake form, pre-filled with what the referral already told us. What the patient submits flows back into the same row.
The document covers the solution design, scope, technology, deliverables, timeline, compliance responsibilities and delivery risks. It has been written so that your operations lead and your compliance officer can both read it without needing a translation layer.
We look forward to putting this in front of your team.
Document History
| Version | Date | Author | Summary of change |
|---|---|---|---|
| 1.0 | September 2026 | Vanaa | Initial proposal issued to PURE |
Confidentiality
This document contains confidential and proprietary information intended solely for the designated recipient. Any unauthorised review, use, disclosure, copying or distribution, in whole or in part, is prohibited. It contains no protected health information.
Contents
Executive Summary
PURE receives patient referrals by fax through GoTo, by email and by phone, all funnelling into a central inbox. Every referral is currently read by a person and typed into a Google Sheet, and every patient then has to be chased by hand until the practice intake form is completed. The cost of this is not only staff time; it is turnaround delay, inconsistent data, forms that are never returned, and no reliable view of where referrals come from or how quickly they convert.
Vanaa proposes an automated referral intake and patient outreach platform that works with PURE's existing tools rather than replacing them.
What the system does
- Pulls every inbound fax directly from PURE’s GoTo account and every referral from the central mailbox, with attachments.
- Converts scanned faxes to text and extracts the structured patient details using AI.
- Validates each record, scores its confidence, and detects referrals that have been sent twice across channels.
- Writes clean records into PURE’s existing Google Sheet with live status tracking.
- Routes anything doubtful to an exception queue for rapid human correction by a Vanaa coordinator.
- Calls the patient with an AI voice agent that names PURE and the referring doctor, explains the call, and sends the form link while the patient is still on the line.
- Follows up by text and by email with a secure, expiring link to PURE’s existing JotForm intake form, pre-filled with what the referral already provided.
- Runs the reminder cadence across all three channels and flags a row for a staff call only once automated outreach is exhausted.
- Pulls completed form submissions back into the same patient row automatically.
- Reports on referral volume, source, performance by outreach channel, form completion and turnaround time, refreshed daily.
Why this approach
Patient records never leave PURE's own Google Workspace tenant. Vanaa provides the processing engine; PURE retains custody of the data. The processing chain runs on a single cloud vendor in a US region under one Business Associate Agreement, which is materially simpler to audit than a chain of four separate vendor agreements. Compliance is treated as a day-one workstream, not a closing task.
Objectives
- Eliminate manual data entry of referrals into PURE’s referral spreadsheet.
- Remove the manual step of retrieving faxes from GoTo, by capturing them at source.
- Reduce the time between a referral arriving and a complete, actionable patient record existing.
- Get PURE’s intake form completed by the patient through automated voice, text and email outreach, without staff phone chasing.
- Preserve PURE's existing workflow and tooling so that staff adoption requires no retraining.
- Keep all patient records inside PURE's own Google Workspace tenant.
- Provide measurable visibility into referral volume, referral sources, outreach performance per channel, form completion rates and turnaround time.
- Build on a HIPAA-aligned processing chain with encryption, role-based access, and complete audit logging.
- Establish a foundation that allows referring provider offices to submit directly over time, removing the fax step entirely.
Target Users
| User | Role in the process |
|---|---|
| Referral coordinators (PURE) | Work referrals from the Google Sheet; act on flagged rows |
| Practice managers (PURE) | Confirm insurance verification, assign provider, record appointment |
| Patients | Take an AI voice call, then complete PURE’s existing JotForm intake form from a texted or emailed link |
| Referring provider offices | Submit referrals directly through a web form instead of by fax |
| Vanaa coordinators | Review and correct low-confidence records in the exception queue |
| PURE leadership | Review referral performance through the reporting dashboard |
Solution Architecture & Data Residency
The platform uses a hybrid architecture, chosen because it is the most defensible option on both reliability and compliance grounds.
Where the data lives
Patient records stay with PURE
The referral mailbox and the referral Google Sheet remain inside PURE’s own Google Workspace tenant, under PURE’s existing agreement with Google. The GoTo fax account and the JotForm intake form likewise stay on PURE’s own accounts. No patient record is migrated out.
Vanaa runs the processing
Vanaa’s infrastructure holds the extraction engine, the outreach engine driving voice, text and email, transient working data, the secure patient links and the audit logs. The system reads from PURE’s environment, processes in the middle, and writes back.
The processing chain
- 1GoTo fax listenerConnects to PURE’s GoTo account and collects each inbound fax the moment it lands, together with the sending number, timestamp and page count.
- 2Mailbox listenerConnects to PURE’s referral inbox through Google’s API with delegated read-only access, scoped to that one mailbox. Picks up each new referral with attachments.
- 3Document readerRuns OCR to convert scanned faxes and image attachments into machine-readable text.
- 4AI extractionExtracts structured fields: patient name, date of birth, phone, email, insurance, referring provider, reason for referral, urgency and preferred location.
- 5Validation & de-duplicationChecks that required fields are present and plausible, catches the same referral sent more than once across fax and email, and attaches a confidence score to every extraction.
- 6Sheet write-backWrites clean records into PURE’s Google Sheet with a live status column.
- 7Exception queueHolds low-confidence or incomplete records for rapid human correction before they reach the sheet.
- 8Outreach enginePlaces the AI voice call, sends the text and the email, issues unique expiring links, runs the reminder cadence across all three channels, and handles replies and opt-outs.
- 9Intake form & submission captureDelivers PURE’s existing JotForm intake form pre-filled with what is already known, tracks whether it is opened and completed, and pulls the submission back into the same patient row.
- 10Reporting layerDaily refreshed dashboard plus a weekly summary emailed to PURE.
Single-vendor processing chain
Compute, storage, OCR and AI extraction all run on AWS in a US region. Keeping the chain with one vendor means a single Business Associate Agreement covers the entire processing path rather than four stitched-together agreements. It is simpler to build, simpler to audit and considerably simpler to present to a compliance officer.
The AI service runs under a signed BAA, in a US region, configured for zero data retention, with a contractual guarantee that data is never used for model training, and with every call logged.
Project Scope
Referral Capture — GoTo Fax & Mailbox
- Direct integration with PURE’s GoTo account to retrieve every inbound fax at source, with sending number, timestamp and page count captured against the record.
- Delegated read-only connection to PURE’s central referral inbox via the Google Workspace API.
- Access scoped to the referral fax line and the referral mailbox only; no access to any other mailbox, Drive content, call recordings or voicemail.
- Automatic retrieval of new referrals including PDF and image attachments from both channels.
- Resilient polling with retry handling so that no fax or email referral is missed during an outage.
- Processing status recorded per fax and per message for traceability.
Document Processing & OCR
- OCR conversion of scanned faxes and image-based attachments into machine-readable text.
- Handling of multi-page referral packets and mixed-quality scans.
- Graceful handling of illegible documents, routed to the exception queue rather than discarded.
- Original source document retained and linked to the resulting record.
AI Extraction, Validation & De-duplication
- Structured extraction of patient name, date of birth, contact number, insurance details, referring provider, reason for referral, urgency and preferred location.
- Field-level validation for presence, format and plausibility.
- Confidence scoring on every extracted record.
- Duplicate detection for referrals received more than once across fax, email and phone channels.
- Configurable confidence threshold determining what passes straight through and what is reviewed.
Google Sheet Write-Back & Exception Queue
- Automated write-back of clean records into PURE's existing referral Google Sheet.
- Live status column reflecting the stage of each referral.
- Agreed sheet structure preserved so that existing staff workflow is unchanged.
- Exception queue interface for Vanaa coordinators to correct low-confidence records.
- Corrections written back to the same row with full audit trail.
Patient Outreach — AI Voice, Text & Email
- AI voice caller places an outbound call to the patient, names PURE and the referring doctor, explains why the practice is calling, and confirms the best number and email address to use.
- The voice agent sends the intake form link by text while the patient is still on the line, and leaves a defined voicemail with a callback path when there is no answer.
- Text and email outreach, each carrying a unique, expiring secure link to the intake form.
- Reminder cadence across channels: text on first contact, email at 24 hours, a second voice attempt at 48 hours, then the row flagged for staff follow-up.
- Inbound reply handling — SMS replies, email replies and return calls — with a routing rule agreed with PURE.
- Opt-out handling on every channel in line with carrier, email and regulatory requirements.
- Every contact names PURE and the referring doctor explicitly, so that patients do not read it as spam or a scam call.
- Call outcome, transcript and channel history logged against the patient row; call recording enabled only if PURE elects it.
Intake Form & Input Surfaces
- PURE’s existing JotForm intake form is used as the patient-facing form — the same form the practice uses today, not a new one for staff to learn.
- The link issued to the patient is pre-filled with the fields already extracted from the referral, so the patient is never asked for what the referring office already sent.
- Completion tracked per patient: link issued, opened, partially completed, submitted.
- Submissions pulled back automatically and written into the same patient row, including uploads such as ID and insurance card.
- Practice manager view — insurance verified, provider assigned, appointment booked.
- Referring provider submission form — allows provider offices to submit directly and bypass the fax channel over time.
- All surfaces write into the same patient row, with no duplicate record creation.
Patient-facing form in scope: purepsychmi.jotform.com/250947671640967 — Pure Psychiatry & ACPC Intake Form.
Reporting & Analytics
- Referral volume by day, week and location.
- Referral source breakdown by referring provider and by channel — GoTo fax, email or phone.
- Outreach performance by channel — voice connect rate, text and email response rate, and reminder effectiveness.
- Intake form completion rate, and time from first contact to submitted form.
- Turnaround time from referral received to complete record.
- Exception rate and extraction accuracy tracking.
- Dashboard refreshed daily, plus a weekly summary emailed to PURE.
Security & Compliance Controls
- Encryption of data in transit and at rest across the processing chain.
- Role-based access control with multi-factor authentication and named users only.
- Restricted access to the exception queue, which is the only surface exposing patient data to Vanaa staff.
- Centralised audit logging across every stage of the chain.
- Secure patient links that are unique, single-patient scoped and time-expiring.
- Documented incident response and breach notification procedure.
- Security overview document prepared for PURE's compliance officer.
Technology Stack
| Layer | Technology | Rationale |
|---|---|---|
| Cloud platform | AWS (US region) | Single BAA across the whole processing chain |
| Fax intake | GoTo API integration | Inbound faxes captured at source, with no manual download |
| Mailbox integration | Google Workspace API | Read-only delegated access, scoped to one mailbox |
| System of record | PURE's Google Sheet | Existing staff workflow preserved |
| OCR | AWS document processing | Handles poor-quality scanned faxes |
| AI extraction | LLM under BAA, zero retention | Structured field extraction with confidence scoring |
| Patient intake form | PURE’s existing JotForm | The practice’s own form, pre-filled and completion-tracked |
| Staff & provider surfaces | Web application (responsive) | Practice manager view and provider submission form |
| Async processing | Queue-based job architecture | Resilience and retry under variable volume |
| Voice outreach | AI voice agent on a HIPAA-eligible telephony provider | Automated patient calls under a signed BAA |
| Text & email | HIPAA-eligible SMS and email providers | Patient outreach under a signed BAA |
| Reporting | Dashboard refreshed daily | Volume, source, per-channel response, form completion, turnaround |
| Monitoring & audit | Centralised logging | Full traceability of every processing step |
Deliverables
- GoTo fax integration capturing every inbound fax at source.
- Mailbox integration with PURE’s central referral inbox.
- Automated extraction engine with OCR, validation, de-duplication and confidence scoring.
- Auto-population of PURE's Google Sheet with live status tracking.
- Exception queue for Vanaa review and correction of low-confidence records.
- AI voice caller for automated patient outreach, with voicemail handling and call logging.
- Automated text and email outreach with reminder cadence, reply handling and opt-out.
- Integration with PURE’s existing JotForm intake form — pre-filled links, completion tracking and automatic write-back of submissions.
- Practice manager input view.
- Referring provider submission form.
- Reporting dashboard refreshed daily, plus a weekly emailed summary.
- Configured environments with controlled deployment and rollback.
- Security overview document for PURE's compliance officer.
- Documented incident response and breach notification procedure.
- Operational runbook and handover session with PURE staff.
Delivery Timeline
Delivery is phased across ten working days to pilot go-live, with a visible checkpoint at the end of each phase. Testing runs in parallel from the moment Phase 1 is testable rather than being bolted on at the end.
Kickoff
Day 1GoTo and mailbox access provisioned, sheet structure agreed, JotForm access confirmed, sample referrals collected, all compliance and registration items submitted.
Phase 1 — Intake
Days 1–4GoTo fax listener, mailbox listener, OCR, AI extraction, validation, de-duplication, sheet write-back, exception queue.
Phase 2 — Outreach
Days 4–6AI voice caller, text and email sending, secure pre-filled JotForm links, reminder cadence, reply handling, submission write-back.
Phase 3 — Input surfaces
Days 6–8Practice manager view, referring provider submission form, and JotForm completion tracking.
Phase 4 — Reporting
Days 8–9Dashboard and weekly summary.
Testing
Days 7–10Accuracy testing, end-to-end runs, edge cases, user acceptance session, security verification.
Pilot go-live
Day 10Launch at one location with live referrals monitored closely.
Rollout
Week 3Remaining locations and tuning against real volume.
The timeline above expresses elapsed working days, not effort. It assumes parallel workstreams and a day-one start conditional on the client dependencies listed in the following section.
Testing coverage
- Extraction accuracy measured against a sample of real historic referrals.
- End-to-end runs using test patients and test numbers before any real patient is contacted.
- Duplicate and edge-case handling, including illegible faxes, missing fields and repeat referrals.
- Voice agent testing against no-answer, voicemail, wrong number, call-back and opt-out paths.
- User acceptance session with PURE staff, approximately half a day.
- Security and access-control verification.
Compliance & Responsibilities
A Business Associate Agreement is in place between Vanaa and PURE. That agreement covers Vanaa as PURE's business associate; it does not extend to the vendors sitting beneath Vanaa, and there are items only PURE can provide. The split of responsibility is set out below.
Required from PURE — ideally on day one
- 01Delegated read-only access to the central referral mailbox, granted by the Google Workspace administrator and scoped to that mailbox onlyPhase 1 cannot begin without it; every day of delay moves the pilot date
- 02GoTo administrator access, or API credentials, for the referral fax line — scoped to inbound fax onlyRequired to capture faxes at source rather than re-keying them from the inbox
- 03Edit access to the referral Google Sheet for the Vanaa service accountRequired for automated write-back
- 04Written confirmation that PURE’s Google Workspace is covered by a BAA with Google, and that the mailbox and sheet sit inside PURE’s own tenantUnderpins the data residency position
- 05JotForm account access with pre-fill and API enabled, plus confirmation of the plan and BAA under which the intake form currently operatesDetermines whether the existing form can be used as-is or needs an account change
- 06A sample of 50–100 historic referrals covering the typical mix of clean emails and poor-quality faxesThe single biggest determinant of extraction accuracy on day one
- 07A decision on the outbound number used for calling and texting patients, and the sending email addressDetermines the carrier registration path, email domain setup and patient response rate
- 08Existing patient communication consent language, and confirmation that referred patients may be contacted by automated call, by text and by emailRequired before any patient is contacted on any channel
- 09Approval of the voice script, the text and email copy, and PURE’s position on call recording and AI disclosureThe patient’s first impression of the practice; also governs state call-recording obligations
- 10A decision on where inbound patient replies and return calls route — to practice staff, or to an automated response pointing to the office lineDefines reply handling behaviour across all three channels
- 11A named contact for privacy and compliance questionsAvoids compliance questions blocking delivery
Handled by Vanaa
- Business Associate Agreements with the SMS, email and voice telephony providers.
- Business Associate Agreement with AWS covering compute, storage, OCR and AI under a single agreement.
- Zero data retention and no-training configuration on the AI service, confirmed in writing.
- Carrier registration for business text messaging (A2P 10DLC), submitted on day one.
- Caller ID registration and branded-call setup for the outbound voice line, to reduce spam-labelling of PURE’s calls.
- Email sending domain authentication (SPF, DKIM, DMARC) so that patient emails are delivered rather than filtered.
- Encryption in transit and at rest, role-based access with MFA, named users only, and restricted access to the exception queue.
- Centralised audit logging across the processing chain.
- Documented incident response and breach notification procedure.
- Security overview document prepared for PURE's compliance officer.
Delivery Risks & Mitigation
The items carrying genuine schedule risk are external rather than technical, and every one of them is initiated on day one.
Carrier registration (A2P 10DLC) for business text messaging
Healthcare messaging attracts additional scrutiny and approval is entirely carrier-controlled, taking anywhere from a few days to a couple of weeks.
Text outreach cannot be tested end-to-end until registration clears. This is the most likely cause of a delay. Voice and email outreach are unaffected and can be demonstrated in the meantime.
Submitted on day one. Pilot launches on a Vanaa number so the deadline does not depend on PURE's carrier, with the process on PURE's own number started in parallel for the week-three rollout.
GoTo and mailbox access from PURE’s IT
Both are straightforward to grant, but they must happen on day one. GoTo access in particular may sit with an external telephony administrator rather than with PURE directly.
Every day of delay comes directly off the front of Phase 1 and moves the pilot date one-for-one.
Requested at kickoff with the exact scope and permissions specified in advance so that the administrator can action it immediately.
Consent for automated calling and email
An automated outbound call to a patient is treated differently from a text under US telemarketing and consent rules, and PURE’s current consent language may cover calls from the practice but not calls placed on its behalf by an automated system.
If the existing consent language does not cover it, the voice channel cannot go live until the wording is updated, and outreach falls back to text and email.
PURE’s consent language is reviewed at kickoff, the voice script opens with a clear identification of PURE and of the automated system, and an immediate route to a human is offered on every call. The channel is built so that it can be switched off independently of the others.
JotForm plan, pre-fill and write-back
Using PURE’s existing intake form depends on the JotForm account supporting pre-filled links and programmatic retrieval of submissions, and on the form operating under a HIPAA-enabled plan with a BAA in place.
If pre-fill or retrieval is not available on the current plan, patients would have to re-enter details the referral already carried, and completion rates fall.
The account configuration is verified in the first two days, before outreach is built. If the existing form cannot be integrated as-is, Vanaa will state the exact plan change required rather than silently building a replacement form.
Referral document quality
Extraction accuracy depends materially on the quality of incoming faxes.
Poor source quality raises the exception rate and increases manual review effort.
Accuracy measured against a real historic sample before go-live, with tuning rounds scheduled inside the delivery window.
Note on the outbound number
There are two routes. Vanaa can provision its own number, which is fast and entirely within our control, but patients see an unfamiliar number calling and texting them from a practice they have only just been referred to, and both answer rates and response rates suffer. Alternatively, calling and text messaging can be enabled on PURE’s existing GoTo number while leaving the phone system itself untouched, so patients see a number they recognise. That is the better patient experience but it requires the carrier’s cooperation and takes longer to arrange.
Whichever number is used, the first call, the first text and the first email will each name PURE and the referring doctor explicitly.
Assumptions & Notes
- The timeline begins on the day GoTo access and mailbox access are granted, sheet edit access is live, JotForm access is confirmed and the historic referral sample has been received. Delay to any of these moves the pilot date accordingly.
- PURE's Google Workspace is covered by a Business Associate Agreement with Google, and the referral mailbox and sheet reside within PURE's own tenant.
- Third-party service charges — voice minutes, SMS messaging, email sending, JotForm subscription, cloud infrastructure and AI processing — are billed at cost and are separate from delivery.
- The existing referral Google Sheet may require structural adjustment to support automated write-back. The agreed structure is fixed at kickoff.
- Extraction accuracy targets are set after review of the historic referral sample, not before.
- Exception queue coverage after go-live is an ongoing operational service, quoted separately from delivery.
- Patient communications, including the AI voice call, are issued in English unless a second language is agreed as an addition to scope.
- The AI voice agent collects and confirms contact details and delivers the intake form link. It does not take clinical information over the phone, and it does not book appointments unless that is agreed as an addition to scope.
- PURE’s existing JotForm intake form remains PURE’s form. Vanaa integrates with it; changes to its questions or structure remain with PURE.
- Changes to scope will be assessed as new requirements and will affect the estimate and timeline.
- Web surfaces are supported on current versions of Chrome, Safari and Edge.
- Commercial terms are provided separately in the accompanying milestone plan and commercial schedule.