Key Updates:

  • New required fields include: member’s address, member’s phone number, and member’s spoken language.
  • Revised questions with more categories to accurately capture dental needs (such as General Anesthesia), including blank space for additional details.
  • New option to identify the requester’s relationship to the member (such as Regional Center Representative).
  • New option for requestor to obtain Case Summary, if permissible per the Health Insurance Portability and Accountability Act

Online Care Coordination Form

California Outreach Map