Faxing Referrals
For specialty care, surgery or procedure referrals, please fax the following to 888-539-8781:
- Patient contact information: name, address, phone number, date of birth
- Copy of insurance card (front and back)
- Insurance authorization, if required
- What service is requested (consultation, diagnostic testing, etc)
- Please give specific provider’s name if requested/known
- Diagnosis, reason for referral
- Copies of progress notes, diagnostic test results that pertain to this visit, including CPT and ICD-9 codes
- Provider’s contact information, including name of office contact
For more information, see Transfers, Referrals and Consultations.