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RAF NUMBER PARTNERSHIP HEALTHPLAN OF CALIFORNIA 360 Campus Lane Suite 100 Fairfield CA 94534 Referral Authorization Form RAF 707 863-4133 or 800 863-4144 707 863-4118 FAX Member Name Referred to Date of Birth ID Address Member Phone City Zip Telephone Consults must be initiated 30 days of date below. Consultants should verify PCP Payment subject to member eligibility. Approval of consultation limited to covered benefits. The consultant name must be the same as that used to bill for these services. TO BE COMPLETED BY THE REFERRING CLINICIAN Services requested Consult and / or Continuing Care 2 months Please call me when you have seen patient. up to 12 mos. I would like to receive periodic status report. from date of issue Call me if procedures or admission planned* Is requested provider contracted with PHC. This referral is If Non-Contracted provider RAF must be approved by PHC before given to member. Urgent potentially life-threatening condition* Indicated important to health not life-....

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A RAF is a referral form used by a Primary Care Provider (PCP) to carry out his/her case management role. It is to be used to refer assigned members for medically necessary services not generally provided by the PCP. Each RAF can only be used once and should contain diagnostic and treatment orders for only one patient.

ERAF is a mechanism enacted in July of 1992 by the State Legislature to shift local property tax revenues from cities, counties, and special districts to an Educational Revenue Augmentation Fund. These funds are allocated by the State to schools to help meet minimum funding requirements.

Referral Authorization Form (RAF) process: is defined as the process by which the primary care provider (PCP) submits a request to Partnership HealthPlan of California (PHC) to refer a PHC enrollee to a specialist for evaluation and/or treatment.

Partnership HealthPlan of California is a non-profit community based health care organization that contracts with the State to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.

ERAF indicates early recurrence of atrial fibrillation.

ERAF is a mechanism; enacted in July of 1992 by the State Legislature to shift local tax revenues from cities, counties, and special districts to a State controlled Education Revenue Augmentation Fund. The state uses this fund to reduce its obligation to the schools.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232