Provider Forms and References

Provider Forms

• Baby Blocks Provider Guide 
• Group Disclosure of Ownership and Control of Interest Form (Last Modified 06.27.2018)
• Individual Disclosure of Ownership and Control of Interest Form (Last Modified 06.27.2018)
• Lock-In Referral Form / Medical Referral Form for Restricted Participants  
• New Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Missed Appointment Process 
• Pregnancy Notification Form
• Request for a Change of Primary Care Provider (PCP) Paper Fax Form

State of Missouri Department of Social Services Forms

• Acknowledgement of Receipt of Hysterectomy Information 
• Risk Appraisal for Pregnant Women
  
• Sterilization Consent Form

• Care Provider Quick Reference Guide - UnitedHealthcare Community Plan of Missouri 
• EPSDT Guide
• Interpreter Services
• Medical Facility Transportation Resource Guide
• Rural Health Clinic Billing Guidelines