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How to use or fill out PAD Referral Form v2 - Passport with DocHub
- Click ‘Get Form’ to open the PAD Referral Form v2 - Passport in our editor.
- Begin by filling in the required fields marked with an asterisk. Start with the *Member ID#, *PCP/PCP Group Name, and the member's full name including *Last Name and *First Name.
- Enter the *Member Date of Birth and the *PCP/PCP Group ID#. Ensure all information is accurate to avoid processing delays.
- In the section labeled 'This member is being referred to', provide details about the specialist or facility, including *Referred to, *Provider ID, and *Specialty type. Fill in the address fields: *Street Address, *City, and *Zip.
- Complete the diagnosis code(s) field as required. Then, check one of the options for referral type and specify the number of visits allowed.
- Finally, sign and date the form at the bottom before sending a copy via fax or email as instructed.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4 Satisfied (26 Votes) |
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