Use this form to refer a member to Peach State Health Plan for outreach from the Drivers of Health Department.

Please check the reason for the referral: required *
Non-Adherence To Treatment Plan:
Drivers:
ED Diversion (three or more ED visits within 90 days)
Recent Inpatient
Identified Health Care Gaps
Reason Type:

1100 Circle 75 Parkway, Suite 1100, Atlanta, GA, 30339 • 1-800-504-8573

 

 

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