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Referral Requirements

The following is a list of the items that are required for a referral to be processed:

Completed "Evaluation Referral Form" Referral Form (PDF)
Recent H&P / Office Visit Note(s)
Height & Weight
Copy of the front and back of the patients’ insurance card(s)
Long Term Care Plan

 

PCP Referral Number on file with patient’s insurance company (Applies to patients with HMO/POS Managed Care Products, and Georgia Better Healthcare only.)