Referral and Authorizations

Text Resize

-A A +A
Referral and Authorizations

A completed referral form is required from your physician to another in-network Jade Health Care Medical Group physician. An service authorization is a request for service that requires formal review by Jade Health Care Medical Group. Please refer to the provider manual to see which services require a service authorization form. The provider manual, referral form and service authorization form is located inside the provider portal. A unique login and password is required.

Jade HCMG Provider Portal

Referral Form/Service Authorization Form (SAF) :

Prescription Drug Authorization Form (PDF) - CCHP Commercial & Covered CA Members
Medication Request Form (PDF) - CCHP Medicare Members Only
Consultation Referral Form (PDF)
Service Authorization Form (PDF)