Colorado Access Care Management Referral Form

This PDF contains the Colorado Access Care Management Referral Form designed for agencies and individuals to refer members in need of care management services. It includes sections for referring agency information, member details, and specific needs such as assistance with primary care or behavioral health. The form also allows for the inclusion of important supporting documents. Referral submissions can be made via email to the provided address, ensuring comprehensive support for the member’s care. For further details, resources like the authorization to disclose PHI form are available on the Colorado Access website.