Referrals

 

We accept referrals in a variety of ways including hard-copy print, email, fax or secure electronic upload. 

 

Electronic Forms

 

Downloadable Forms
Download Referral Form
Authorization & Consent
Online Referral Form
Secure Electronic Records Upload
Section 111
Queries and Reporting
CMS Queries
ORM & TPOC Input
Having trouble downloading our referral form? Click here. 
Documents Needed for Allocations

In order to prepare the most accurate allocation possible, we need the following documents:

  • Most recent two years of medical records

  • First report of injury in workers' compensation cases

  • Claims payment history/listing

  • Pharmacy printout

  • Summary of medications (if available)

  • Completed referral form