This form is to be submitted to Partners for Quality Health.

Referral form for children ages 0-3 to receive Department of Health (DOH) Early Intervention Services (EIS) for developmental delay.

This resource can be filled out by the patient prior to their visit. The patient agenda allows the patient to articulate their needs and capture screening questions before the visit occurs.

Sample self management tool to help patients reach their health care goals.

Link to the Woman, Infant and Children (WIC) Prescreening Tool that can be used to determine eligibility for WIC benefits. Services are also available for fathers and guardians.

Primary Care Provider Selection Form for HMSA Members

This form is to be submitted to Partners for Quality Health.