EPSDT Forms

Referrals are frequently used in the EPSDT program to faciliate diagnosis and treatment of various health conditions in Medicaid-enrolled children.
Forms
Form 172 EPSDT Child Health Medical Record (optional form)
Form 362 Medicaid Referral Form - Fillable  
362 - I Instructions for completing the Alabama Medicaid Referral Form 
EPSDT Provider Agreement EPSDT Provider Enrollment Form