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Primary care provider referral forms

 

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Denver/North

Use this form to send your patient's medical information to a new health care professional. This form is required for most HMO plans.

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O4 2 Columns (1/2 - 1/2)
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Colorado Springs/South

Use this form to send your patient's medical information to a new health care professional. This form is required for most HMO plans.

Download now