Get Mn Ucare Medical Referral For Ucare Restricted Recipient Enrollee 2016-2025

Filling out the MN UCare Medical Referral For UCare Restricted Recipient Enrollee form online is a crucial step in ensuring that the necessary referrals are processed smoothly. This guide provides step-by-step instructions to assist users in accurately completing this form, facilitating better healthcare outcomes.

Follow the steps to successfully complete the online form.

1. Press the ‘Get Form’ button to access the document and open it in the editing interface.
2. Enter the date in the appropriate field to indicate when the referral is being made.
3. In the 'Recipient Name' field, provide the full name of the individual receiving the referral.
4. Input the date of birth (DOB) of the recipient in the designated area.
5. Fill in the UCare ID number, which is essential for identification.
6. In Section I, provide the primary physician's name along with their NPI number.
7. Supplies the clinic's street address, phone number, city, state, and zip code for the primary physician.
8. In Section II, detail the referral information by including the name of the person being referred to and their specialty.
9. Input the referring provider's NPI number and the clinic name for the specialist.
10. Fill out the street address, city, state, and zip code of the referral clinic.
11. Provide the phone number for the referral provider's office.
12. Clearly state the reason for the referral and include the appropriate ICD10 code.
13. Indicate whether the referral is for a visit only or if it includes the option to prescribe medications if deemed appropriate.
14. Specify the expected start and end dates for the referral.
15. Include the primary care provider's signature, print their name, and affix the date of signing.
16. Once completed, save the form to preserve your input, then download, print, or share it as needed.

Complete your forms online to ensure timely processing of your referrals.