Disease, Case and Lifestyle Management

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To refer patients to HealthPartners Health and Lifestyle support services please complete this form or call 952-883-5469 or 1-800-871-9243

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Referring provider information

* Provider organization name

* Practitioner first name

* Practitioner last name

Contact information

* First name

* Last name

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* Phone #

Ext.

Fax #

Member information

* First name

* Last name

* Member #

* DOB

* Gender Male Female

* Phone #

Best time to call

* Address

* City

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* Reason for referral

* Is member aware of referral? Yes No

Services Available

Telephonic support for patients who need assistance in managing their health. Services are tailored to best support the patient in reaching their health goals.

There is no cost to the patient.

Case Management
Telephonic support for patients at risk of hospitalization

Medical

* Specify situation/condition

Behavioral Health

Restricted Recipient (Chemical misuse/addiction; inappropriately seeking care from multiple providers)

Disease or Condition
Telephonic support and education for patients with select conditions

Lifestyle Management
Telephonic coaching to support lifestyle changes

Tobacco Cessation

Adult Obesity Telephone Coaching

Weight Loss Surgery

For HealthPartners commercial and Medical Assistance medical members over the age of 18 and with a BMI > 30 only

HealthPartners medical members that are candidates for surgery must complete this course (5 sessions) prior to surgery.

Pharmacy
Review of patient’s medications by a pharmacist either telephonically or face to face at select locations

MTM-(Medication Therapy Management)