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Get Alameda Care Management Programs Referral Form 2015-2025
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How to fill out the Alameda Care Management Programs Referral Form online
Completing the Alameda Care Management Programs Referral Form online can streamline the referral process for individuals seeking care management services. This guide provides detailed, step-by-step instructions to ensure accurate and efficient submission of the form.
Follow the steps to complete your referral form successfully.
- Click the ‘Get Form’ button to access the form and display it in your online editor.
- In the 'A. Referring Provider Information' section, provide the date you are submitting the referral, your name as the person filling out the form, and your contact phone number. Additionally, include the name of your facility or clinic and any relevant fax number.
- Indicate the referral source by selecting the appropriate option, such as 'Hospital', 'PCP', 'Specialty Provider', or 'Community Partner' by checking the box next to your choice.
- Move to the 'B. Member Information' section. Here, enter the member’s full name, date of birth, address, and city. Also, provide their age, sex, and ZIP code, along with a contact phone number for the member, which can be their home or cell number.
- In the 'C. Referral Information' section, identify the reasons for referral by checking all applicable options. The available choices include 'Asthma Intervention', 'Diabetes Intervention', 'Community Based Resources and Services', 'Complex Medical Concerns', and 'Care Coordination for Medical Needs'.
- Review all the information for accuracy and completeness before moving on to submit the form.
- Once you have filled out the form completely, save your changes. You may choose to download, print, or share the completed form as needed.
Take the first step in managing care by completing the Alameda Care Management Programs Referral Form online today.
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While you cannot enroll in Kaiser directly through Alameda Alliance, there may be pathways available if you have Medi-Cal benefits. It's always wise to explore your healthcare choices and confirm acceptance based on your specific plan. Complete the Alameda Care Management Programs Referral Form to help clarify your options and connect with appropriate services.
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