Get the free fhcp referral form

FLORIDA HEALTH CARE PLANS REFERRAL FORM Phone: 386-238-3230 Fax: 386-238-3253 Date: A. Auth #: Member Name: Referring Provider Name: MAN: Date of Birth: Referring Provider Phone #: Home Tel: Work

How to fill out fhcp referral form

To fill out the fhcp referral form, you will need the following information:

1. Personal details: Include your full name, date of birth, address, and contact information.
2. Insurance details: Provide your insurance information, including the name of your insurance provider, your policy number, and any other pertinent information required by FHCP.
3. Referring physician's information: Input the name, contact details, and specialty of the physician who is referring you for further medical treatment or consultation.
4. Reason for referral: Clearly state the reason for the referral, whether it is for a specific medical condition, specialist consultation, or treatment authorization.
5. Additional documentation: If there are any relevant medical reports, test results, or supporting documents related to your referral, make sure to attach them to the form.
6. Members of FHCP's health insurance plans who need to see a specialist or obtain specific services that require prior authorization will likely need to fill out this referral form.
7. Patients who have been recommended by their primary care physician for specialized treatment or consultation will need to complete this form to ensure proper communication and coordination of care.
8. Individuals seeking services that fall outside of their primary care physician's scope or expertise may also require this referral form to be completed.

Remember, it is crucial to carefully review and accurately fill out the fhcp referral form to avoid any delays or complications in accessing the necessary medical care.

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