florida health care plans east volusia area network referral instructions

More documents

Recommendations

Info

OPHTHALMOLOGY Central Florida Eye Specialists Kevin Barber, M.D. #10A214 Robert Cordero, M.D. #003829 Thomas Kropp, M.D. #004057 Infants and older Sakowitz Eye Center Howard Sakowitz, M.D. #002412 Eric Cohn, D.O. #002496 Douglas Lieb, M.D. Huberto Perez, M.D. #10B846 Patients 10 years and older 305 E. New York Avenue, DeLand, FL 32724 2445 S. Volusia Ave., Unit C-1, Orange City, FL 32763 313 N. Mangoustine Avenue, Sanford, FL 32771 1061 Medical Center Drive, Suite 204, Orange City, FL 32763 386 / 734-2931 Fax: 386 / 734-2939 386 / 917-0404 Fax: 386 / 917-0584 386 / 574-0700 Fax: 386 / 574-1139 386 / 574-0700 Fax: 386 / 574-1139 REFERRAL INSTRUCTIONS: Complete the FHCP Referral form. The requesting provider should call this specialist directly to schedule an appointment. Pre-authorization from the FHCP Referral Department is not needed. Confirm the appointment with the patient and record the appointment date and time at the bottom of the request form. Distribute the form as follows: White: Send, via courier, to the FHCP Referral Advisor at the Orange City facility. Pink: Attach pertinent dictation and documentation and forward to the specialist’s office, via FHCP courier. Yellow: To be retained in requesting provider’s records. Blue: Give to the member as a reminder of their appointment date and time. Preferred Medical Centers – Holly Hill Todd Geis, M.D. #000091 Marc Koblick, M.D. #000788 F. Harold Kushner, M.D. #000007 All ages 1340 Ridgewood Avenue, Holly Hill, FL 32117 386 / 676-7100 Ext. 7103 Fax: 386 / 615-4076 REFERRAL INSTRUCTIONS: Complete the FHCP Referral form. The requesting provider should call this specialist directly to schedule an appointment. Pre-authorization from the FHCP Referral Department is not needed. Confirm the appointment with the member and record the appointment date and time at the bottom of the request form. Distribute the form as follows: White and Pink: Attach pertinent dictation and documentation and forward to the specialist’s office, via FHCP courier. Yellow: To be retained in requesting provider’s records. Blue: Give to the member as a reminder of their appointment date and time. Copies of most recent dictation, PE if done within the past year, last CBC and last EKG must be included with the <strong>referral</strong>. 58 WEST 06/01/08
OPTOMETRY Total Vision Eye & Contact Lens Center Charles Heacock, O.D. #000482 Jeffery Timko, O.D. #000473 Patients 4 years and older Total Vision Eye & Contact Lens Center Dustin H. Ramey, O.D. #001057 Kirsten Wilgers, O.D. #001219 Patients 4 years and older 840 N. Stone Street, DeLand, FL 32720 386 / 734-1766 Fax: 386 / 734-0281 2836 Enterprise Road, DeBary, FL 32713 386 / 668-8885 Fax: 386 / 668-3301 INSTRUCTIONS: With the exception of Healthy Kids participants, members may call this provider directly and schedule an appointment. Healthy kids must have failed a screening eye exam resulting in an Optometry Request being completed by the PCP. The parent may then call directly to schedule an appointment, but must bring the completed Optometry request with them to the Optometry appointment. 59 WEST 06/01/08
Page 1 and 2:
FLORIDA HEALTH CARE PLANS EAST VOLU
Page 3 and 4:
FLUOROSCOPIC PROCEDURES............
Page 5 and 6:
ULTRASOUND ........................
Page 7 and 8:
2 EAST 06/01/08 FLORIDA HEALTH CARE
Page 9 and 10:
ALLERGY Robert DiNicolo, M.D. # 001
Page 11 and 12:
DIABETIC SHOE PROVIDERS Atlantic Po
Page 13 and 14:
CARDIOLOGY Preferred Medical Center
Page 15 and 16:
CHIROPRACTIC Lawrence Petker, D.C.
Page 17 and 18:
DENTAL SERVICES Preferred Medical C
Page 19 and 20:
DIABETES EDUCATION Florida Health C
Page 21 and 22:
DIALYSIS SERVICES DVA Healthcare Re
Page 23 and 24:
Acute Low Back & Neck Pain • This
Page 25 and 26:
EAR LAVAGE Florida Health Care Plan
Page 27 and 28:
EMG TESTING Preferred Medical Cente
Page 29 and 30:
FLUOROSCOPIC PROCEDURES Twin Lakes
Page 31 and 32:
GENETIC TESTING All Genetic Testing
Page 33 and 34:
GYNECOLOGY AND WELL WOMAN’S ASSES
Page 35 and 36:
HOME HEALTH CARE Doctors’ Choice
Page 37 and 38:
HOSPITAL SURGERY Halifax Health #00
Page 39 and 40:
INFUSION / INJECTION CLINIC Florida
Page 41 and 42:
LYMPHEDEMA CLINIC Halifax Health #0
Page 43 and 44:
NEPHROLOGY Nephrology Consultants,
Page 45 and 46:
NEUROLOGY (cont’d) Coastal Neurol
Page 47 and 48:
OBSTETRICS Halifax OB/GYN Associate
Page 49 and 50:
ONCOLOGY - MEDICAL/HEMATOLOGY (cont
Page 51 and 52:
OPHTHALMOLOGY Preferred Medical Cen
Page 53 and 54:
ORTHOPAEDICS Preferred Medical Cent
Page 55 and 56:
OSTOMY SERVICES Florida Health Care
Page 57 and 58:
BALANCE & VESTIBULAR THERAPY Univer
Page 59 and 60:
PAIN MANAGEMENT (cont’d) Ambulato
Page 61 and 62:
PHARMACY FHCP Pharmacy 350 N. Clyde
Page 63 and 64:
PODIATRY Atlantic Podiatry Associat
Page 65 and 66:
PRIMARY CARE (cont’d) Pablo Garci
Page 67 and 68:
SUBSTANCE ABUSE, DETOXIFICATION AND
Page 69 and 70:
PULMONOLOGY Suresh D. Desai, M.D. #
Page 71 and 72:
RHEUMATOLOGY - PEDIATRICS Children
Page 73 and 74:
SMOKING CESSATION PROGRAM QuitSmart
Page 75 and 76:
SURGERY-CARDIOVASCULAR Coastal Card
Page 77 and 78:
MINOR SURGICAL CLINIC Harry H. Blac
Page 79 and 80:
SURGERY - PLASTIC Vijay Moradia, M.
Page 81 and 82:
SURGERY - VASCULAR Surgical Associa
Page 83 and 84:
URGENT CARE SERVICES MediQuick Urge
Page 85 and 86:
VARICOSE VEIN TREATMENT Thomas Corb
Page 87 and 88:
WOUND CARE CLINIC Florida Health Ca
Page 89 and 90:
FLORIDA HEALTH CARE PLANS SOUTHEAST
Page 91 and 92:
FLUOROSCOPIC PROCEDURES............
Page 93 and 94:
ULTRASOUND ........................
Page 95 and 96:
FLORIDA HEALTH CARE PLANS OUTPATIEN
Page 97 and 98:
ALLERGY Robert DiNicolo, M.D. # 001
Page 99 and 100:
DIABETIC SHOE PROVIDERS Atlantic Po
Page 101 and 102:
CARDIOLOGY Yogesh Shah, M.D. #01045
Page 103 and 104:
CHIROPRACTIC Michelle Gingras, D.C.
Page 105 and 106:
DENTAL SERVICES Preferred Medical C
Page 107 and 108:
DIABETES EDUCATION Florida Health C
Page 109 and 110:
DIALYSIS SERVICES DVA Healthcare Re
Page 111 and 112:
Acute Low Back & Neck Pain • This
Page 113 and 114:
EAR LAVAGE Florida Health Care Plan
Page 115 and 116:
EMG TESTING Preferred Medical Cente
Page 117 and 118:
FLUOROSCOPIC PROCEDURES Bert Fish M
Page 119 and 120:
GASTROENTEROLOGY (cont’d) Nagrani
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
INFECTIOUS DISEASES Daniel Warner,
Page 127 and 128:
LABORATORY SERVICES - ROUTINE LabCo
Page 129 and 130:
MRI’S Bert Fish Medical Center #0
Page 131 and 132:
NEUROLOGY Preferred Medical Centers
Page 133 and 134:
Page 135 and 136:
OPHTHALMOLOGY Robert C. Dean, M.D.
Page 137 and 138:
ORTHOPAEDICS Atlantic Orthopaedic A
Page 139 and 140:
OSTOMY SERVICES Florida Health Care
Page 141 and 142:
BALANCE & VESTIBULAR THERAPY Univer
Page 143 and 144:
PAIN MANAGEMENT (cont’d) Ambulato
Page 145 and 146:
PHYSICAL MEDICINE AND REHABILITATIO
Page 147 and 148:
PSYCHIATRY / BEHAVIORAL HEALTH Marg
Page 149 and 150:
Page 151 and 152:
PULMONOLOGY Suresh D. Desai, M.D. #
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
SURGERY-CARDIOVASCULAR Coastal Card
Page 159 and 160:
SURGERY-GENERAL Avrohm Faber, M.D.
Page 161 and 162:
SURGERY - ORAL Peter J. Linek, D.D.
Page 163 and 164:
SURGERY - THORACIC Coastal Cardiova
Page 165 and 166:
SUTURE AND STAPLE REMOVAL Florida H
Page 167 and 168:
URGENT CARE SERVICES MediQuick Urge
Page 169 and 170:
VARICOSE VEIN TREATMENT Thomas Corb
Page 171 and 172:
WEIGHT MANAGEMENT PROGRAM Halifax F
Page 173 and 174:
FLORIDA HEALTH CARE PLANS WEST VOLU
Page 175 and 176:
EVENT MONITOR......................
Page 177 and 178:
SURGERY-THORACIC ..................
Page 179 and 180: ***********************************
Page 181 and 182: ALLERGY Asthma & Allergy Specialist
Page 183 and 184: BRACES / ORTHOTICS / PROSTHETICS Am
Page 185 and 186: CARDIAC CATHETERIZATION Florida Hos
Page 187 and 188: CARDIOLOGY (cont’d) Central Flori
Page 189 and 190: CHIROPRACTIC James Jeremy Hether, D
Page 191 and 192: CT’S Florida Hospital - DeLand #0
Page 193 and 194: DERMATOLOGY Acclaimed Dermatology R
Page 195 and 196: DIAGNOSTIC TESTING Florida Hospital
Page 197 and 198: DISEASE MANAGEMENT PROGRAMS The lis
Page 199 and 200: DURABLE MEDICAL EQUIPMENT Apria Hea
Page 201 and 202: EAR, NOSE AND THROAT (ENT) Coastal
Page 203 and 204: EMG TESTING Central Florida Neurolo
Page 205 and 206: EVENT MONITOR Florida Health Care P
Page 207 and 208: GASTROENTEROLOGY Central Florida Ga
Page 209 and 210: GENETIC TESTING All Genetic Testing
Page 211 and 212: GYNECOLOGY AND WELL WOMAN’S ASSES
Page 213 and 214: HOLTER MONITOR Florida Health Care
Page 215 and 216: HOSPITAL SURGERY Florida Hospital -
Page 217 and 218: INFUSION CLINIC Florida Health Care
Page 219 and 220: LABORATORY SERVICES - ROUTINE Flori
Page 221 and 222: MRI’S Florida Hospital - DeLand #
Page 223 and 224: NEPHROLOGY Nephrology Consultants,
Page 225 and 226: NEUROLOGY (con’t) Preferred Medic
Page 227 and 228: OBSTETRICS Halifax OB/GYN Associate
Page 229: ONCOLOGY-RADIATION Florida Oncology
Page 233 and 234: ORTHOPAEDICS - SPORTS MEDICINE (Non
Page 235 and 236: ***********************************
Page 237 and 238: PAIN MANAGEMENT Pain Management & R
Page 239 and 240: PEDIATRICS Preferred Medical Center
Page 241 and 242: PHYSICAL MEDICINE AND REHABILITATIO
Page 243 and 244: PRIMARY CARE Preferred Medical Cent
Page 245 and 246: PSYCHIATRY / BEHAVIORAL HEALTH Fami
Page 247 and 248: PULMONARY FUNCTION TESTS (PFT’s)
Page 249 and 250: RABIES VACCINE SERIES Volusia Count
Page 251 and 252: RHEUMATOLOGY - PEDIATRICS Children
Page 253 and 254: SMOKING CESSATION PROGRAM QuitSmart
Page 255 and 256: SURGERY-CARDIOVASCULAR Coastal Card
Page 257 and 258: SURGERY-GENERAL Rene Capulong, M.D.
Page 259 and 260: SURGERY - ORAL Peter J. Linek, D.D.
Page 261 and 262: SURGERY-THORACIC Corbyons & Donohoe
Page 263 and 264: SURGERY - VASCULAR Surgical Associa
Page 265 and 266: ULTRASOUND Florida Health Care Plan
Page 267 and 268: UROLOGY Atlantic Urology Associates
Page 269 and 270: VNG TESTING Timko Hearing and Balan
Page 271 and 272: X-RAYS (PLAIN FILMS) Florida Health
Page 273 and 274: TABLE OF CONTENTS ACUTE LOW BACK &
Page 275 and 276: OUTPATIENT REHABILITATION .........
Page 277 and 278: ACUTE LOW BACK & NECK PROGRAM This
Page 279 and 280: AFTER HOURS PRIMARY CARE FHCP Pedia
Page 281 and 282:
BONE DENSITY STUDIES Florida Health
Page 283 and 284:
CARDIAC CATHETERIZATION Florida Hos
Page 285 and 286:
CARDIOLOGY - PEDIATRIC Pediatric Ca
Page 287 and 288:
CT’S Florida Hospital - Flagler #
Page 289 and 290:
DERMATOLOGY Acclaimed Dermatology R
Page 291 and 292:
DIAGNOSTIC TESTING Florida Hospital
Page 293 and 294:
DISEASE MANAGEMENT PROGRAMS The lis
Page 295 and 296:
DURABLE MEDICAL EQUIPMENT Apria Hea
Page 297 and 298:
EEG TESTING Florida Hospital - Flag
Page 299 and 300:
EVENT MONITOR Florida Health Care P
Page 301 and 302:
GENETIC TESTING All Genetic Testing
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
INFECTIOUS DISEASES Daniel A. Warne
Page 309 and 310:
LABORATORY SERVICES - ROUTINE Flori
Page 311 and 312:
MRI’S Florida Hospital - Flagler
Page 313 and 314:
NEUROLOGY Preferred Medical Centers
Page 315 and 316:
Page 317 and 318:
ONCOLOGY - MEDICAL/HEMATOLOGY (cont
Page 319 and 320:
OPHTHALMOLOGY Preferred Medical Cen
Page 321 and 322:
ORTHOPAEDICS - SPORTS MEDICINE (Non
Page 323 and 324:
FLORIDA HEALTH CARE PLANS OUTPATIEN
Page 325 and 326:
PAIN MANAGEMENT Pain Management & R
Page 327 and 328:
PEDIATRICS Preferred Medical Center
Page 329 and 330:
PODIATRY Atlantic Podiatry Associat
Page 331 and 332:
Page 333 and 334:
PULMONOLOGY Lawrence Burns, M.D. #0
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
SURGERY - CARDIOVASCULAR Coastal Ca
Page 341 and 342:
SURGERY-GENERAL Alfred Alson, M.D.
Page 343 and 344:
SURGERY - ORAL Peter J. Linek, D.D.
Page 345 and 346:
SURGERY - VASCULAR Surgical Associa
Page 347 and 348:
ULTRASOUND Florida Health Care Plan
Page 349 and 350:
UROLOGY Atlantic Urological Associa
Page 351 and 352:
VNG TESTING Timko Hearing and Balan
Page 353:
X-RAYS (PLAIN FILMS) Florida Health
show all

florida health care plans east volusia area network referral instructions

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?