Authorizations and Referrals

Eating Disorder Precertification Checklist

This form must be filled out by you (the parent or legal guardian) in order to receive eating disorder services. Fax the application to Health Net Federal Services, LLC at 1-844-818-9289. You can also have your doctor send the form for you.

• Created: Aug 1, 2022
• Modified: Dec 5, 2018
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Application for Residential Treatment Center – Family

This form must be filled out by you (the parent or legal guardian) in order to have your child placed in a Residential Treatment Center. Fax the application to Health Net Federal Services, LLC at 1-844-818-9289. You can also have your doctor send the form for you.

Health Net Federal Services will look at the request once we receive both your family application and your provider application.

• Created: Aug 1, 2022
• Modified: Dec 5, 2018
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