Helpful Hints for the Passport Health Plan Referral Form
The Passport Health Plan Referral Form must be completed by the primary care provider (PCP) and distributed to the appropriate parties. The Plan must receive the correct copy in order for payment to be made to specialists.
Completing the Form
All fields on the form must be completed. Here is a quick reference guide:
Top of Form
"Please Note" Box
"Referred to" Section
Reasons for Referral
Distributing the Form
Here is a quick reference guide for the appropriate distribution channels:
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