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DIRECT REFERRAL AUTHORIZATION FORM ... After completing this form, the referring provider can send a copy to the specialist ... Rev. July 5, 2016.

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What is gchp direct referral authorization?

GCHP direct referral authorization is a form that authorizes a patient to see a specialist without first seeing a primary care physician.

Who is required to file gchp direct referral authorization?

Patients who wish to see a specialist directly without going through their primary care physician are required to file GCHP direct referral authorization.

How to fill out gchp direct referral authorization?

To fill out GCHP direct referral authorization, patients must provide their personal information, reason for specialist visit, and any relevant medical history.

What is the purpose of gchp direct referral authorization?

The purpose of GCHP direct referral authorization is to streamline the process for patients to see a specialist and receive necessary medical care.

What information must be reported on gchp direct referral authorization?

GCHP direct referral authorization must include patient's personal information, reason for specialist visit, and any relevant medical history.

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