CalAIM pDF Documents

Forms Required for the calaim Referral Application

For the Adobe Sign versions (easier!), click the links on the CalAIM Community Support Referral Package Instructions page.

In addition to the Physician’s report (602), and member’s diagnostic codes, we’ll need the the following forms:

1. Referral Package Check List

2. CalAIM Combined Referral Form: Member Summary Form, Participant Liability Waiver, Freedom of Choice Waiver, HIPAA Release Form and Room and Board Payment Attestation.

3. Declaration for CalAIM SNF Diversion/Transition Eligibility

4. RCFE 602 Physician’s Report