Health Plus - Referral Information and Forms

Referral Information and Forms

Health Plus Referral Form (for CHP, FHP and Medicaid members only) - ( PDF, 50KB)

Health Plus DM/CM Referral Form for disease or case management services - ( PDF, 110KB)

How to Refer a Member for Specialty Care (CHP, FHP and Medicaid only) - ( PDF, 81.4KB)

W-9 Form and Instructions - ( PDF, 326KB)

Health Plus Elite (Medicare) Referral Form - ( PDF, 40KB)

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