MIH Referral

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MIH Referral

Your Name/Unit (required)

Incident # associated with the patient

Patient's Name (required)

Address / If Homeless, best location

Phone Number

Is there a better person to contact about the patient other than the patient?

--- If "Yes", then list name and phone number

What is your main concern / challenge with the patient?

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10545 Armstrong Ave., Suite 200
Mather, California 95655-4102

Monday - Friday 8:00 AM - 5:00 PM

Phone: (916) 859-4300

Fax: (916) 859-3702

Home
Resident
Business
- Requests for Proposals/Bids
- Request a Report
Risk Reduction
For Kids
About Us
How Do I

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