Managed Care Referral Request Form

To make a referral for managed care request, use this online form, filling in all fields completely, and click "submit".

If you prefer, you may also download and print a Managed Care Referral Request Form (.pdf), which you may fill out and mail or email back to us according to the instructions found on the form. Further questions should be directed to rboubin@mnscha.org.

Last Updated: 5-14-10

H5703 CMS SCHA 4006 ACARE 109; Approved 9-5-06 | H2419 CMS SCHA 4006 MSHO 72; Approved 9-5-06