Printable blank Alabama Medicaid Referral Form Phi-Confidential

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What is an Alabama Medicaid Referral Form PHI-Confidential?

Fillable Alabama Medicaid Referral Form PHI-Confidential is a form that allows referring a patient to a screening procedure, treatment, hospitalization, billing, and so on. 
PHI stands for Protected Health Information, as the form contains sensitive and valuable information regarding the patient’s current, past or possible future health condition. 

What do I need the Alabama Medicaid Referral Form PHI-Confidential for?

This form is used by doctors to assign a screening test to a patient. It is necessary for confirming or rejecting a diagnosis, as well as assessing the overall condition of a person’s health and also providing treatment or forming a bill. 

How to fill out Alabama Medicaid Referral Form PHI-Confidential?

The form requires just a bit of a patient’s personal info and details on which medical procedure should be applied.

Form filling requires:

  • Recipient info. Address, telephone, code area and DOB of the recipient.
  • Provider details. Write in full contact information of the medicare provider: telephone, email, medicaid provider number and address.
  • Referral specification. Choose one of the options —  evaluation, treatment, hospital care, and so forth.

At the end of the form you should also select a reason why a procedure must take place. Results can be submitted to the Primary Care Physician only due to privacy reasons. 

Organizations that work with Alabama Medicaid Referral Form PHI-Confidential

Alabama Department of Public Health.

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