Forms

For the Healthy Louisiana Plans to submit referrals to Magellan
CSoC MCO Referral Form
For the Wraparound Agency to submit to Magellan when child/youth is transitioned or discharged out of CSoC.
CSoC Discharge Form
For providers reporting an adverse incident occurrence.
CSoC Adverse Incident Reporting Form
For members to submit formal appeal in writing.
CSoC Member Appeal Form
For providers interested in becoming a Magellan Provider.
LA CSoC Interested Provider Form and W-9 Form
This form must accompany the Plan of Care (POC) if this service is needed
Psychological Testing Form
(English-Spanish)
CSoC Bilingual Plan of Care Form
For all youths enrolling in CSoC when authorization is being made at the time of enrollment
Freedom of Choice Form
(Spanish) For all youths enrolling in CSoC when authorization is being made at the time of enrollment
Freedom of Choice Form
(Vietnamese) For all youths enrolling in CSoC when authorization is being made at the time of enrollment
Freedom of Choice Form
Used when adding a service, along with the Plan of Care, after enrollment
Freedom of Choice Provider Form
(Spanish) - Used when adding a service, along with the Plan of Care, after enrollment
Freedom of Choice Provider Form
(Vietnamese) - Used when adding a service, along with the Plan of Care, after enrollment
Freedom of Choice Provider Form
Used to create roster of behavioral health staff
Organizational Behavioral Health Roster Staff

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