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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.
Select the type of initial KP referral by checking the appropriate box and enter the Initial KP Auth # if available.
Input patient details including 'Patient Name', 'Kaiser I.D. #', and 'Fax'. Ensure accuracy for seamless processing.
Indicate the number of authorized treatments used and how many treatments have been utilized this calendar year.
Check the request for additional treatments (Chiropractic, Acupuncture, Naturopathic) and specify 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, and expected outcomes.
Finally, sign and date the form before forwarding it via fax to the Kaiser Permanente Community Medicine Integration Center at 877-800-5456.
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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.
CHP+ covers doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments. CHP+ can help you and your
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