Get Ar Dms-2610 2019-2025

The AR DMS-2610 form is essential for managing referrals in the Arkansas Medicaid Primary Care Physician Managed Care Program. This guide will help you navigate the online filling process with ease, ensuring that all necessary information is accurately provided.

Follow the steps to complete the AR DMS-2610 effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member's personal information. Fill in the first name, last name, middle initial, Medicaid ID number, Social Security number, birth date, mailing address, city, state, zip code, home phone, cell phone, and email address in the designated fields.
3. In the Medicaid providers receiving referral section, list at least two providers of the same type or specialty. For each provider, enter their first and last name, Medicaid provider ID number, and the date of the referral.
4. Provide details regarding the clinical assessment of the patient. Use the designated space to describe any findings, diagnoses, and treatment plans related to the service for which you are making the referral.
5. Indicate whether the referral is for a diagnostic or corrective treatment identified during an initial or periodic EPSDT screening service by checking ‘Yes’ or ‘No’.
6. Print, stamp, or type the primary care physician's name in the appropriate section. Include the Medicaid provider number and/or taxonomy code.
7. Sign the form in the specified field for the primary care physician. Also, provide the PCP phone number and date of completing the form.
8. Once all sections are completed, review the information for accuracy. After confirming that everything is correct, you can save changes, download, print, or share the form as needed.

Complete your AR DMS-2610 form online today for efficient processing of your referrals.