Referrals Hub

Connecting individuals and organizations to the right level of care and support. We streamline the path from referral to enrollment.

Referral Forms

Staff Intake Form

Internal Use Only. For Risen Health Partners clinical staff and case managers to register new members into the system.

Self-Referral Form

For individuals or family members seeking Medi-Cal services for themselves or a loved one. Start your journey here.

Organization Referral Form

For Hospitals, Clinics, Shelters, and CBOs. Use this form to refer a client for ECM or Housing Navigation services.

Parental Consent Form

Required for any member under the age of 18. This form must be signed by a parent or legal guardian to authorize services.

HIPAA Authorization

Standard Release of Information (ROI) form. Allows us to share medical records and coordinate care with other providers.

Who Can Submit a Referral?

Risen Health Partners operates on a “No Wrong Door” policy. We accept referrals from a wide network of community partners to ensure vulnerable populations get the help they need immediately. Referrals are accepted from:

  • Hospitals & Discharge Planners: For patients transitioning home or to a shelter.

  • Managed Care Plans (MCPs): Health Net, Molina, L.A. Care, and others.

  • Homeless Services Providers: Shelters, Navigation Centers, and Street Medicine teams.

  • Self & Family: You can always refer yourself or a family member directly.

We aim to process all referrals and verify eligibility within 24-48 hours.

Medical content reviewed and validated by Ekaterina Timofeeva, PhD.