Referral form

Send a referral.

Share the basics below. No patient names and no medical details: we take the specifics by phone. Our Care Network Director reviews every request and follows up to help organize appropriate next steps. For urgent discharges or details that should be discussed directly, call (818) 574-3333.

Fields marked * are required. How we handle what you send is in our Privacy Policy.

Referring party

Your name

Role / title

Organization

Phone

The person who needs care

This online form is for adults 18 and older. Please do not include the person's name.

AgeIn whole years. Adults 18 and older.

Funding / insurance type

Service needed

Current setting

County for the next setting

Preferred location

Urgency

Preferred language for communicationThe language the person or family prefers for follow-up.

Care needs

Describe the situation

I understand this form is for basic referral information related to care coordination and resource navigation. It is not for emergencies, medical advice, clinical assessments, or submission of detailed protected health information.I confirm that I am authorized to submit this referral and authorize Prime Care Link to use the information provided to respond to the request and, when needed, share relevant basic referral information with potential care providers, facilities, or service organizations for care-navigation and coordination purposes.

One click sends your referral to Prime Care Link. For emergencies, call 911. For same-day or sensitive matters, call (818) 574-3333.

Prefer to talk?

Speak directly with our Care Network Director for urgent discharge timing, sensitive details, or questions that need more context.

Care coordination across California·TTY 711

Office hours Mon–Fri · 8am–6pm PT · TTY 711. After hours, call the same number.

(818) 574-3333 Email

Basic details only

Use this form for basic referral information only. Do not include names, medical records, Social Security numbers, medication lists, diagnosis details, or detailed medical history. Clinical documents go directly from the referring team to the provider the patient chooses.

Prime Care Link helps coordinate access to healthcare providers, care services, places to live with care, and community resources for adults 18 and older across California. We do not provide clinical care, medical advice, clinical assessments, or emergency services, and we do not make admission or placement decisions. Final care decisions remain with the person, the family or legal representative, and licensed providers.