Provider Resources Gold Coast Health Plan 2025

1. Click ‘Get Form’ to open the Provider Resources Gold Coast Health Plan in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's name, date of birth, and contact details accurately. Ensure that you include the CIN number and mailing address for proper identification.
3. Next, complete the Ordering Provider section. Indicate whether you are referring an In-Network or Out-of-Area provider. Fill in your name, contact information, specialty, and TIN/NPI numbers.
4. Proceed to the Referral Specialist Information section. Provide the specialist's name, phone number, address, and specialty details. This ensures that all necessary information is conveyed for a smooth referral process.
5. Finally, sign and date the form at the bottom to validate your referral. Make sure to verify eligibility at the time services are rendered.

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