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Get Kern Family Health Care Referral/prior-authorization Form
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How to fill out the Kern Family Health Care Referral/Prior-Authorization Form online
Completing the Kern Family Health Care Referral/Prior-Authorization Form online is essential for ensuring timely processing of healthcare requests. This guide provides clear instructions on filling out each section of the form to facilitate your submission.
Follow the steps to accurately complete the form
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Indicate the type of request by selecting either 'Routine' or 'Urgent/Expedited'.
- Select the product type by checking one of the options: KFHC Medi-Cal, KFHC Healthy Families, or GHP.
- Complete the member information section by filling in the patient's name, contact information, address, city, state, KFHC Member ID number, date of birth, zip code, daytime phone, and age.
- Specify whether the patient has a CCS (California Children's Services) eligible condition by checking ‘YES’ or 'NO'. If yes, provide the Alternate ID number and CCS open case number.
- In the facility/provider information section, input the requesting provider's name, phone number, fax number, address, and signature. Also, enter the date and list the requested service(s) along with the corresponding ICD-9 and CPT codes.
- Select any additional requested services from the provided list, ensuring all relevant services are checked.
- Complete the diagnosis and clinical problem section by providing necessary details. Include clinical history and date of onset.
- Attach any relevant clinical documentation, such as progress notes or lab reports, which may be required to facilitate processing.
- After completing all sections, review the form for accuracy and completeness. Once confirmed, you can save changes, download, print, or share the filled-out form.
Complete your forms online for efficient health care processing.
The rapid re-housing program in Bakersfield, CA, aims to quickly transition individuals and families from homelessness to permanent housing. This program offers a variety of resources, including financial assistance and housing services. If you need help accessing these resources, the Kern Family Health Care Referral/Prior-Authorization Form can guide you through the process.
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