Initial Referral for Family Based Services - Magellan Provider's 2026

1. Click ‘Get Form’ to open the Initial Referral for Family-Based Services in our platform.
2. Begin by entering the 'Date of Referral' and 'Referring Agency Provider #' at the top of the form. Ensure all details are accurate to avoid processing delays.
3. Fill in the 'Referring Agency Staff', 'Phone', and 'Fax #' fields. This information is crucial for communication regarding the referral.
4. In the 'Recommended FBS Provider' section, specify your choice and provide a rationale if applicable. This helps clarify your recommendation.
5. Ensure that consent has been obtained from a parent/guardian/member over age 14 by checking 'Yes' or 'No'. Include the date received for record-keeping.
6. Complete sections on member details, including name, DOB, MA ID #, current age, gender, school name, and home address. Accurate demographic information is essential.
7. Discuss family dynamics and any other agencies involved in the member's care. This context is vital for understanding the member's situation.
8. Finally, review all entries before submitting. Once completed, fax all four pages to 866-667-7744 as instructed.

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