Get the free Fairfield Medi-Cal Referral Authorization Form (RAF)

Medical Referral Authorization Form (RAF)PARTNERSHIP HEALTHILY OF CALIFORNIA 4665 Business Center Drive Fairfield, CA 94534 (707) 8634133 or (800) 8634144 FAX # (707) 8634118 www.partnershiphp.orgSpecialty

How to fill out fairfield medi-cal referral authorization

How to fill out fairfield medi-cal referral authorization

1. Obtain the Fairfield Medi-Cal referral authorization form.
2. Fill out the patient information section, including name, date of birth, address, and Medi-Cal ID number.
3. Provide the referring physician's information, including their name, NPI number, and contact information.
4. Specify the reason for the referral and the requested services or specialist.
5. Attach any necessary supporting documentation, such as medical records or test results.
6. Sign and date the form.
7. Submit the completed referral authorization form to the appropriate Medi-Cal office or healthcare provider.

Who needs fairfield medi-cal referral authorization?

1. Any Medi-Cal recipient residing in Fairfield and in need of specialized medical services or consultations that require a referral from their primary care physician.

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What is fairfield medi-cal referral authorization?

Fairfield Medi-Cal referral authorization is a form used to obtain approval for a patient to see a specialist or receive a certain medical service covered by Medi-Cal.

Who is required to file fairfield medi-cal referral authorization?

Healthcare providers, such as primary care physicians, are typically required to file Fairfield Medi-Cal referral authorization on behalf of their patients.

How to fill out fairfield medi-cal referral authorization?

Fairfield Medi-Cal referral authorization can be filled out by providing the patient's information, medical service requested, reason for referral, and any additional documentation required.

What is the purpose of fairfield medi-cal referral authorization?

The purpose of Fairfield Medi-Cal referral authorization is to ensure that patients receive the necessary approval to see a specialist or receive specific medical services covered by their Medi-Cal plan.

What information must be reported on fairfield medi-cal referral authorization?

Information such as patient demographics, medical history, reason for referral, preferred specialist, and any supporting documentation must be reported on Fairfield Medi-Cal referral authorization.