Gateway health plan ob gyn referral form 2026

1. Click ‘Get Form’ to open the gateway health plan OB/GYN referral form in the editor.
2. Begin by filling out the PROVIDER INFORMATION section. Enter the OB/GYN Provider Name and Provider Number, ensuring accuracy for claims processing.
3. Next, move to the PATIENT INFORMATION section. Fill in the Patient Name, Gateway Member ID#, and Provider Phone Number. This information is crucial for identifying the patient and their coverage.
4. In the DIAGNOSIS/COMPLAINT field, provide a brief description of the patient's condition. This helps in justifying the referral.
5. Complete the FACILITY INFORMATION section by entering the Facility Name and Facility Provider ID#. Ensure that these details match with your chosen facility.
6. Select any referred services needed, such as lab testing or other specified services. Make sure to follow guidelines regarding designated laboratories.
7. Finally, have the OB/GYN sign and date the form. An unsigned form will be considered invalid, so ensure this step is completed before submission.

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