Get Denver Health Referral Form

Filling out the Denver Health Referral Form online is an essential step in ensuring that patients receive the appropriate care and referrals they need. This guide will provide you with clear instructions on how to complete each section of the form accurately to facilitate the referral process.

Follow the steps to fill out the Denver Health Referral Form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Fill in the patient's name (first, middle, last), date of birth, phone number, address, city, state, and zip code. If the patient is a child, include the name of the parent.
3. Next, provide the referral information. Indicate the patient's sex by selecting either 'Male' or 'Female'. Include the diagnosis and/or ICD 10 code, as well as a secondary contact number if applicable.
4. Select the priority of the referral. You can choose from options: 'Routine', 'Urgent', or 'Elective'. If 'Urgent' is selected, provide a detailed description of the urgency.
5. Specify the clinic or specialty being requested. Additionally, state the clinical question that needs to be addressed.
6. Indicate whether an interpreter is needed by selecting 'Yes' or 'No' and provide the preferred language if applicable.
7. Fill in the insurance information, including the insurance carrier, member ID, and subscriber name.
8. Complete the referring provider information. Input the referring provider's name, phone number, practice name, fax number, practice address, email, city, state, and zip code. Also include the provider's NPI number and the name and phone number of the primary care provider (PCP).
9. Finally, indicate if any additional documentation is included by marking the relevant clinical notes such as history & physical, imaging, and lab results.
10. After ensuring all sections are completed accurately, you can save your changes, download, print, or share the completed form as required.

Complete your Denver Health Referral Form online today to streamline your healthcare referrals.