SERVICES REFERRAL PROCESS

1. Company or Pinal County Department will submit a letter of agreement (see attached sample) to the Central Support and Accounting (CSA) department, Attn: Gwena Vincent, P.O. Box 2945, Florence, Arizona 85132-2945.
2. Company will contact the District Nursing Supervisor to schedule appointments for their employees.
3. Company or Pinal County Department will send the Authorization Form with the employee for each visit to the clinic (i.e. 3 Hep B shots = 3 separate Authorization Forms). All immunizations administered on a single date can be noted on the same Authorization Form.
4. Administering nurse will note on the form what immunizations or services have been administered and forward the original form to CSA.
5. CSA will use these forms to bill the Company or Pinal County Department. The original form will be returned with the invoice so the Company or Pinal County Department can retain as part of the employee’s personnel records.