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 6/23
(includes instructions for completing the Alabama Medicaid Referral Form)
Form 362 Alabama Medicaid Referral Form (fillable) - Revised 10/23