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A Medical Referral Note is the recommendation of a medical or paramedical professional. If you get a referral to ophthalmology, for example, you are being sent to the eye doctor. In HMOs and other managed care schemes, a referral is usually necessary to see any practitioner or specialist other than your primary care physician (PCP), if you want the service to be covered. The referral is obtained from your PCP, who may require a telephone or office consultation first.
The term "referral" can refer both to the act of sending you to another doctor or therapist, and to the actual paper authorizing your visit.
Sources: https://www.medicinenet.com/script/main/art.asp?articlekey=5265
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