Health Education Referral Form - Gold Coast Health Plan - goldcoasthealthplan 2026

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  1. Click ‘Get Form’ to open the Health Education Referral Form in the editor.
  2. Begin by filling out the PATIENT INFORMATION section. Enter the member's last name, first name, middle initial, and member ID number. Provide the address, primary and secondary phone numbers, date of birth, city, state, and zip code.
  3. Next, move to the REFERRAL INFORMATION section. Here, input the treating physician's name along with their phone and fax numbers. Also include the primary care physician's (PCP) name and contact details.
  4. In the REASON(S) FOR REFERRAL TO GOLD COAST HEALTH PLAN HEALTH EDUCATOR section, check all applicable boxes that correspond to the patient's condition such as Diabetes or Asthma.
  5. Finally, complete the CLINICAL INFORMATION section by having the treating physician or office staff fill in their name, title, phone number, and date of completion.

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Reach Our Member Services Department We can answer your questions in English or in Spanish. If you speak a language other than these, we will be happy to provide the interpreter services you need. Just give us a call at 1.888. 301.1228.
What is Gold Coast Health? Gold Coast was created by the Ventura County Board of Supervisors 13 years ago to administer Medi-Cal insurance to low-income residents. Though its defined as a county-organized health system, it operates as an independent public entity and does not answer directly to the supervisors.
Urgent enquiries and emergencies At all times (including after hours), call us on 1300 GOLDCOAST (1300 465 326) and choose option 1 to be diverted to our Emergency Service number.
GCHP is your health plan in Ventura County after you qualify for Medi-Cal. You will be automatically enrolled in GCHP one to two months after you are eligible. GCHP will send you a new member packet. GCHP covers most Medi-Cal services.
If you would like more information, call GCHP at 1.888. 301.1228. If you use a TTY/TDD, call 711.

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