Dean health plan 2026

1. Click ‘Get Form’ to open the dean health plan in the editor.
2. Begin by filling out the 'Patient Demographics' section. Enter the patient's name, date of birth, member ID, phone number, and address details including city, state, and zip code.
3. Next, provide 'Referring Provider Information.' Fill in the provider's name, phone number, address, fax number, city, state, provider number, zip code, and specialty.
4. In the 'Genetics Health Care Provider Information' section, input the details of the clinical geneticist or counselor including their name and contact information.
5. Complete the 'Clinical Information' section by entering dates of service, diagnosis codes (ICD), and any relevant CPT/HCPCS codes for requested tests.
6. Finally, ensure that all required signatures are obtained before submitting. You can fax your completed form directly from our platform to 608-252-0830.

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