Get Carefirst Referral Form

Filling out the Carefirst Referral Form online is a crucial step in ensuring that patients receive the appropriate care and consultations. This guide provides clear and detailed instructions for completing the form effectively, making the process straightforward for all users.

Follow the steps to complete the Carefirst Referral Form online.

1. Press the ‘Get Form’ button to obtain the Carefirst Referral Form and open it in the provided editor.
2. Begin with section 1, 'Patient Information.' Carefully fill out all required fields, including name, date of birth, phone number, and ID number. Ensure accuracy to avoid processing delays.
3. Move to section 2, 'Carrier Information.' Circle the name of the carrier, either CareFirst BlueChoice or CareFirst BlueCross BlueShield, and enter the date of referral.
4. In section 3, 'Primary or Requesting Provider,' complete the provider’s full name, specialty, institution/group name, and provider IDs. Include address and phone number.
5. Proceed to section 4 for 'Consultant/Facility Provider.' Enter the consultant’s name, specialty, institution/group name, and provider IDs along with their contact details.
6. In section 5, 'Referral Information,’ provide the reason for referral and any relevant brief history, diagnosis, and test results to facilitate understanding.
7. Section 6, 'Service Desired,' requires you to specify the services needed. Mark the appropriate options and enter the number of visits, noting that if left blank, it defaults to three visits.
8. Complete section 7, 'Place of Service.' Check the appropriate box for the service location and fill in the referral validity date. Include any required authorizing signatures.
9. Once you have filled all the sections, review the form for accuracy. Save any changes made, and proceed to download, print, or share the completed form as required.

Complete your Carefirst Referral Form online today for efficient processing and care coordination.