Logo of CountyCare featuring a large C composed of varying blue shades. Beside it, the text reads CountyCare with the tagline A Medicaid Health Plan underneath in smaller font.

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Logo of CountyCare featuring a large C composed of varying blue shades. Beside it, the text reads CountyCare with the tagline A Medicaid Health Plan underneath in smaller font.

Remisión a Coordinación de atención

Los campos marcados con * son obligatorios

The Care Coordination Program helps CountyCare members with medical, behavioral health, and support services to improve their health care. Care Coordinators help members use their benefits to get needed services and find their way through the health care system. Members with specific health needs may also enroll in Care Management and/or Disease Management Programs.

Clinicians, Discharge Planners, Utilization Reviewers and Caregivers: Please use this form to refer members to these programs. Within five (5) business days of receiving this referral, a Care Coordinator will reply to the contact people listed on this form. If the need is more urgent, please call 312-864-8200, 711 (TDD/TTY) and press option 4, then option 8.

Members: If you want to refer yourself to Care Coordination, you can bypass this form by sending an email message through the Member Portal at https://countycare.com/members/portal

Who is completing this form?

Los campos marcados con * son requeridos
Date: *

Member Information
DOB: *
Phone Type *
Reason for Referral (check all that apply) *
Logo of CountyCare, a Medicaid health plan, featuring a large letter C composed of segmented lines. The text CountyCare is to the right, with A Medicaid Health Plan below it in smaller font. The design is in white on a transparent background.

Nuestro departamento de Servicios para Miembros está listo para ayudarle a obtener lo mejor de su plan de salud.

Número de teléfono de los Servicios para Miembros:
312-864-8200
855-444-1661 (sin costo)
711 (TDD/TTY)

Horarios de atención:
De lunes a viernes: 8:00 a. m. a 6:00 p. m.
Sábado: 9:00 a. m. a 1:00 p. m.

Sobre nosotros 
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A circular blue and white badge with Accredited NCQA Health Plan written in red and white text. The word Accredited appears at the top and bottom of the circular border.
Logo of HealthChoice Illinois featuring a white geometric design resembling a four-pointed star next to the text HealthChoice Illinois.
The image displays the text Cook County Health in bold white letters on a transparent background.
Seal of Cook County, Illinois. Features a central design with a silhouette of the state and cityscape, a ship, and a book with the date January 1831. Encircled by the text Seal of Cook County Illinois.

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©2025 Cook County Health. All rights reserved. 

Cuidado con las estafas. Illinois nunca le pedirá dinero para renovar o solicitar Medicaid. Report scams to the sitio web or the Medicaid fraud hotline at 1-844-453-7283/1-844-ILFRAUD.

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