Steward referral 2026

1. Click ‘Get Form’ to open the steward referral in the editor.
2. Begin by filling out the MEMBER INFORMATION section. Enter the member's name, date of birth, phone number, and member ID. Ensure that the address is complete with city, state, and zip code.
3. Select the appropriate plan by checking one of the options: Steward Employee Choice, Steward Community Choice, or FCHP Steward Community Care.
4. In the PRIMARY CARE PROVIDER (PCP) section, input the PCP's name, office phone number, NPI number, and fax number. Don’t forget to include the signature of an authorized PCP along with the date.
5. For SPECIALIST AND/OR HOSPITAL REFERRED TO, provide the name and NPI number of the specialist or hospital. Fill in their address and contact details as well.
6. In DIAGNOSIS/REASON FOR REFERRAL, clearly state why you are referring to a specialist outside of the network and attach any necessary clinical documentation.
7. Indicate NUMBER OF VISITS REQUESTED by checking one of the options provided for consultative opinions or therapy visits.

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