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Make a Referral to Care Coordination |
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Referrals are received via the Local
Health Services Request form (DHMH 4582).
Referrals are initiated by the Managed Care Organization
after outreach measures to reach their member have failed.
Primary Care Providers should refer to the MCO Provider Manual
for details on how to refer their patients.
Referrals should be sent to the Local Health Department ACCU
in the jurisdiction where the patient resides.
These addresses may be found on the back of the referral
form. In Baltimore
City, all requests should be sent to: Baltimore
HealthCare Access Care
Coordination Program 201
E. Baltimore Street, Suite 1000 Baltimore,
MD 21202 Attention:
Kimberly Parker, RN BSN, Program Manager To obtain copies of the Local Health Services Request form, please call (410) 649-0500. You may also download a copy of the form below or go to our Publications page to order print copies.
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Timely responses to all service requests are sent in writing to the enrollee's Managed Care Organization. |
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Local Health Services Request Form (DHMH 4582)
Available Soon. Order print copies here. |
