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Referral Form Referred person must be receiving FIP, GA, GRH, GAME, or MSA.PERSON BEING REFERRED: Telephone DOMAIN # AddressSSNREFERRING PERSON: Telephone Agency FAX AddressEMailREFERRAL CHECKLIST: ?
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Anyone who requires mental health services and is eligible for Medicaid may need the bartowgafcporgfilesmental-health-referral-formmedicaidmental health services referral.

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The bartowgafcporgfilesmental-health-referral-formmedicaidmental health services referral is a document used to refer individuals to mental health services covered by Medicaid in Bartow County.
Healthcare providers, social workers, and authorized personnel involved in patient care are required to file this referral form.
To fill out the form, you must provide patient details, including their identification, medical history, and the specific mental health services needed.
The purpose of the referral form is to efficiently connect patients with necessary mental health services and ensure that they receive appropriate care under Medicaid.
The form must report patient demographics, diagnosis, treatment history, and the type of mental health services being requested.
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