Get Gateway Health Plan Ob Gyn Referral Form

Filling out the Gateway Health Plan Ob Gyn Referral Form online can simplify the referral process for patients and providers alike. This guide will walk you through each section of the form, ensuring a smooth experience as you complete it accurately.

Follow the steps to successfully complete your referral form.

1. Click ‘Get Form’ button to access the Gateway Health Plan Ob Gyn Referral Form and open it in the editor.
2. Begin with the provider information section. Enter the OB/GYN provider name in the designated space. This identifies the healthcare professional being referred.
3. Next, input the OB/GYN provider number, which should be six digits long. This number is essential for processing the referral.
4. Proceed to the patient information section. Fill in the patient’s name clearly and accurately in the provided field.
5. Include the Gateway member ID number, which consists of nine digits. This helps verify the patient's membership in the Gateway Health Plan.
6. Provide the provider's phone number formatted as three digits followed by a hyphen and then four digits. This ensures the receiving party can contact the provider if needed.
7. Next, describe the diagnosis or complaint in detail. This will assist in determining the necessary services for the referral.
8. Select the designated laboratory for the referral and note it in the 'Designated Laboratory' field, ensuring lab tasks are routed correctly.
9. In the facility information section, fill out the facility name where the services will be rendered. Provide the facility provider ID, again composed of six digits.
10. Indicate the type of referred services. Specify whether lab testing is performed by a non-designated lab or if it falls under 'Other' services.
11. Ensure to sign the OB/GYN signature field; an unsigned form will be considered invalid. Include the referral date in the format of month, day, and year.
12. Finally, save your changes, download, print, or share the completed form as necessary before mailing it to the address provided on the form.

Complete your Gateway Health Plan Ob Gyn Referral Form online and streamline your referral process today.