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Please fax completed form to your Sunshine State Health Plan CONNECTIONS Representative Fax 1 866 796-0527. CONNECTIONS REFERRAL FORM Use this Form to refer a member to Sunshine State Health Plan for a visit from a CONNECTIONS Representative. Date To From Member Name Medicaid ID Member Phone Member Address 1 Address Apt. City State Provider Name Zip Code Fax Please check the reason for the Referral Non-Compliance Missed Appointments minimum of 3 - With appropriate documentation High Emergency...
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