Tools & Forms
Healthcare tools, forms, and resources
Information and forms for clients, families, physicians, and care providers—supporting compliance, safety, and clear communication in our community.
Maintaining compliance, safety & communication
Resources for our community and partners
The tools, forms, links, and resources here can help you find more information about support and services near you. They also help providers and physicians maintain transparency and communication as we work together in the community.
If you are a physician, care provider, client, or member of the public with questions or concerns about care, compliance, or programs, we encourage you to get in touch with us at 1-800-884-3335.
Referral forms
Making a referral
If you are a physician making a referral for services, you can find the appropriate form here. Please call our offices or fax the form to us, along with a copy of the H&P and medications list.
- Download the referral form
- Additional department referral forms (coming soon)
Partner physicians
For physicians seeking more information
Please contact our partner physicians in your area:
Jennifer Tesoro
Mt. Pleasant
313 E. Remus, Ste. B
Mt. Pleasant, MI 48858
Phone: (989) 775-5500
Fax: (989) 775-5550
Kathy Sauvola
Pigeon
P.O. 80, 88 S. Main St.
Pigeon, MI 48755
Phone: (989) 453-2828
Fax: (989) 453-2824
Provider tools & links
Health care provider resources
Contracted providers are required to attend annual provider training with A&D MI Choice Waiver. Providers must also remain current and in compliance with Waiver Contract Attachments and Operating Standards.
If you have questions regarding contracting requirements or other provider-related matters, please contact our Contract Specialist, Melissa Little, at 1-800-884-3335.
- Our list of partner health care providers
- Current FY Waiver Contract Attachments for review
- Current FY Operating Standards for review
- Current FY Audit Tool for Providers
- Current FY Home and Community Based Compliance Tool
Report abuse, neglect, or exploitation
There is no excuse for elder abuse
If you suspect that someone is being harmed, neglected, or taken advantage of, it’s important to speak up. Warning signs can include sudden changes in behavior, unexplained injuries, poor living conditions, or unusual financial activity. Even if you’re unsure, reporting your concerns can help ensure the individual’s safety.
To report abuse, neglect, or exploitation of an elderly or vulnerable person in Michigan, call Central Intake: 1-855-444-3911. You will remain anonymous.
Report fraud
Report fraud, waste, or abuse of Medicaid funds
Protecting the integrity of Medicaid helps ensure resources are available for those who truly need them. If you suspect misuse of Medicaid funds in Michigan, report your concerns:
MDHHS Office of Health Services Inspector General
P.O. Box 30479
Lansing, MI 48909-7979
Toll Free: (855) 643-7283
State Attorney General
Health Care Fraud Division — Medicaid Fraud Control Unit
P.O. Box 30218
Lansing, MI 48909
Phone: 1-855-MI-FRAUD (855) 643-7283
Online: www.michigan.gov/fraud
Questions? We're happy to help
If you don’t see the information you need here, give us a call.