(TER to KP Direct Referrals) - The CHP Group: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the 'Referring Kaiser Clinician' and 'Treating CHP Provider' fields, along with their respective phone numbers. This information is crucial for communication regarding the referral.
Indicate the type of initial KP referral by checking the appropriate box and entering the Initial KP Auth # if available.
Complete patient details including 'Patient Name', 'Kaiser I.D. #', and 'Fax'. Ensure accuracy as this information is vital for processing.
In the treatment section, specify the number of authorized treatments used and how many treatments have been utilized this calendar year.
Request additional treatments by checking the relevant option (Chiropractic, Acupuncture, Naturopathic) and indicate how many additional treatments are requested along with the dates.
Provide detailed information on initial complaints, pain scores, objective findings, diagnosis, treatment provided, response to treatment, current complaints, objective findings, and expected outcomes.
Finally, sign and date the form before forwarding it via fax to Kaiser Permanente Community Medicine Integration Center at 877-800-5456.

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What are CHP providers?

CHP removes barriers to high-quality healthcare by building connections between community providers that enhance health and wellbeing through a holistic approach to individual and community wellness. Our goal at CHP is to provide data-driven, people-centered solutions to healthcare providers in engaged communities.

What is CHP in healthcare?

As an officer of the California Highway Patrol, your job is providing safety, service, and security to Californians and visitors to our state. Officers do much more than write tickets. The CHP is a very diverse agency that performs many different duties ranging from patrolling the streets to protecting the Governor.

What is the CHP group with Kaiser?

The CHP Group provides chiropractic services to Kaiser Permanente members with plans that include chiropractic benefits. Depending on your plan, you can either self-refer to a chiropractor or a referral from your primary care physician may be required.