Get Ma Tempus Unlimited Consumer Referral Form 2017-2025

Completing the MA Tempus Unlimited Consumer Referral Form online is a straightforward process designed to facilitate user referrals effectively. This guide will provide you with detailed instructions on how to accurately fill out each section of the form.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the form and open it in the document editor.
2. In the first section, fill in the referral date and the assigned consumer number, which is crucial for processing your request.
3. Provide the consumer's personal details such as their name, email address, and phone numbers. It is essential to ensure that all information is accurate for effective communication.
4. Enter the home address and mailing address if different. Ensure all addresses are current to prevent delays.
5. Input the consumer's Social Security number and date of birth to verify their identity. Check for accuracy in these critical fields.
6. Indicate the consumer's gender by selecting the appropriate option.
7. Complete the MassHealth MMIS number and any other program IDs if applicable, as these are often necessary for insurance processing.
8. Answer whether the consumer is a minor and provide the care program details.
9. Select the primary language spoken by the consumer to ensure appropriate services are provided.
10. If the consumer is a minor, include the names and relationships of the parents or guardians.
11. Report any previous PCA services and the associated EIN if applicable.
12. Identify the program the consumer is currently enrolled in, such as FFS or SCO, along with the specific agency names.
13. If there is a surrogate, fill out their information, including their relationship to the consumer.
14. Decide where the welcome package should be mailed, choosing between the agency, consumer, or surrogate.
15. Lastly, fill in the skills trainer or case manager's contact information and ensure all sections are complete.
16. Once completed, review all entries for accuracy. You can save the changes, download the form, print it, or share it as needed.

Start completing the MA Tempus Unlimited Consumer Referral Form online today!