Referral Forms

In many cases, a referral to another doctor or clinic is needed for services or care. Referrals are used in the ACHN, EPSDT, Case Management and Lock-In programs, among others.

Forms
Form 362 Alabama Medicaid Referral Form - Revised 8/19
Form 362 Alabama Medicaid Referral Form (fillable) - Revised 8/19
362 - I Instructions for filling out Form 362 - Revised 8/19