Kaiser permanente referral form 2026

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The document is a Uniform Consultation Referral Form for Kaiser Permanente, designed to facilitate the referral process between primary care providers and specialist consultants. It includes sections for patient information, provider details, referral reasons, desired services, and authorization requirements. The form emphasizes that referral certification does not guarantee payment and outlines the importance of member eligibility.

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Click ‘Get Form’ to open the Kaiser Permanente referral form in the editor.
Begin by entering the 'Date of Referral' at the top of the form. This is essential for tracking your request.
Fill in the 'Patient Information' section, including the patient's name, address, date of birth, and phone number. Ensure accuracy for effective communication.
In the 'Primary or Requesting Provider' section, input the provider's name, specialty, institution/group, and contact details. If there are two provider IDs required, make sure to include both.
Next, complete the 'Consultant/Facility Provider' section with similar details as above. This helps in identifying where care will be provided.
For 'Referral Information', specify the reason for referral and provide a brief history or diagnosis. Clearly outline any desired services and place of service.
Indicate the number of visits expected; if left blank, one visit is assumed. Lastly, sign where indicated to authorize the referral.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the Kaiser retention bonus?

Earn $40 per member on eligible renewing Kaiser Permanente Individual and Family members from the 2023 plan year who are retained through December 31, 2024. To qualify you must: Retain through December 31, 2024, at least 70% of total members renewed and newly enrolled during the 2023 plan year.

How do I see my referrals on Kaiser?

Appointments tab, click on more. You will see the referrals option.

How much bonus do you get for a referral?

Referral bonuses will significantly impact your hiring efforts, which is why having a good employee referral bonus is important. Employee referral bonuses can range anywhere from $1,000 to $10,000. Employee referrals are known to improve the time to fill a position by 40%.

How to get a referral from Kaiser Reddit?

If the specialty dept is one you do not already have a relationship with, you need to communicate with your PCP what your concern is and can they make a referral in the system for you. If you are interested in a specific doctor, say that. The specialty dept. should then reach out to you by phone or Kaiser messaging.

Does Kaiser give referral bonuses?

Yes, Kaiser Permanente offers a job referral program. Kaiser Permanente employees may refer friends and family members for open positions and receive a referral bonus if their referral is hired.

kaiser referral form pdf

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Does Kaiser Permanente require a referral to see a specialist?

Some types of specialty care dont require a referral, including Ob/Gyn, optometry, and mental health. To make an appointment for specialty care that doesnt require a referral, call the Appointment and Advice Call Center at 1-866-454-8855 or schedule online.

Kaiser permanente referral form 2026

Here's how it works

How to use or fill out kaiser permanente referral form with our platform

Complete this form in 5 minutes or less

Got questions?

What is the Kaiser retention bonus?

How do I see my referrals on Kaiser?

How much bonus do you get for a referral?

How to get a referral from Kaiser Reddit?

Does Kaiser give referral bonuses?

Security and compliance

Complete this form in 5 minutes or less

People also ask

Does Kaiser Permanente require a referral to see a specialist?

how to get a referral from kaiser california

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