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
(includes instructions for completing the Alabama Medicaid Referral Form) |
| Form 362 |
Medicaid Referral Form - Fillable |
| EPSDT Provider Agreement |
EPSDT Provider Enrollment Form |